摘要
目的探讨关节镜下缝线联合锚钉“×”形弹性固定治疗前交叉韧带(ACL)胫骨止点撕脱骨折的临床疗效。方法于2018年3月至2023年6月对35例ACL胫骨止点撕脱骨折患者,应用自制后交叉韧带(PCL)胫骨止点骨折隧道制作和过线装置,在关节镜下实施缝线联合锚钉“×”形弹性固定改良Meyers-McKeever分型Ⅱ~Ⅳ型骨折。末次随访根据膝关节Lysholm评分及IKDC评分评估手术疗效。结果35例均获随访,随访时间6~18个月,平均12.3个月。术后复查CT证实骨折复位良好,均获骨性愈合(愈合时间3~5个月,平均4.1个月)。末次随访时前抽屉试验、Lachman试验均阴性,膝关节Lysholm评分、IKDC评分分别从术前(23.25±5.12、39.02±6.71)分提升至末次随访的(93.60±3.38、91.83±4.21)分(P<0.001)。所有病例无关节感染、内固定松动、关节交锁及不稳等并发症发生。儿童或青少年患者无骨骺早闭、膝内或外翻畸形等生长紊乱。结论关节镜下缝线联合锚钉“×”形弹性固定治疗ACL胫骨止点撕脱骨折,复位精确,固定可靠,允许膝关节早期功能康复。同时应用自制PCL胫骨止点骨折隧道制作和过线装置,使操作简捷,对骨骺干扰小,临床效果满意。
Objective To explore the clinical efficacy of suture anchor shaped“×”elastic fixation in the treatment of anterior cruciate ligament(ACL)tibial insertion avulsion fracture under the arthroscopy.Methods From March 2018 to June 2023,35 patients with ACL tibial insertion avulsion fractures were treated with tunnel fabrication and threading device for posterior cruciate ligament(PCL)tibial insertion avulsion fracture(self-made),and suture anchor shaped“×”elastic fixation was performed to the modified Meyers-McKeever classification of typeⅡ~Ⅳfractures under the arthroscopy.In the final follow-up,the evaluation of the surgical efficacy was based on the Lysholm score and IKDC score of the knee joint.Results For all the 35 cases,the follow-up lasted for 6-18 months,with an average of 12.3 months.Postoperative CT follow-up showed that all 35 cases obtained satisfactory reduction of the fracture and bone healing(healing time lasing 3-5 months,with average of 4.1 months).In the last follow-up,both the anterior drawer test and the Lachman test were negative.The Lysholm score and IKDC score of the knee joint increased from(23.25±5.12,39.02±6.71)points(preoperative stage)to(93.60±3.38,91.83±4.21)points(the last follow-up stage),respectively(P<0.001).All cases had no complications such as joint infection,internal fixation loosening,joint interlocking,or instability.Children or adolescent patients did not have growth disorders such as premature closure of epiphysis,knee varus or valgus deformities.Conclusion The application of suture anchor shaped“×”elastic fixation to treat ACL tibial insertion avulsion fracture under the arthroscopy achieved precise fracture reduction and reliable fixation,allowed early functional rehabilitation of the knee joint.The self-made tunnel fabrication and threading device for PCL tibial insertion avulsion fracture are used to make the operation more simple,the interference to the epiphysis is small,and the clinical effect is satisfactory.
作者
刘张冰
江杉
蔡文斌
杜兵
邹俊涛
Liu Zhangbing;Jiang Shan;Cai Wenbin;Du Bing;Zou Juntao(Department of Orthopaedics,the People’s Hospital of Honghuagang District of Zunyi City,Zunyi Guizhou 563000,China)
出处
《遵义医科大学学报》
2024年第5期502-507,共6页
Journal of Zunyi Medical University
基金
贵州省卫健委基金资助项目(NO:gzwkj2023-383)。
关键词
锚钉
弹性固定
关节镜
前交叉韧带
撕脱骨折
anchor
elastic fixation
arthroscopy
anterior cruciate ligament
avulsion fracture
作者简介
刘张冰,男,硕士,副主任医师,研究方向:运动医学,E-mail:542044314@qq.com。
