关节镜下不可吸收缝线联合微型钢板固定治疗前交叉韧带胫骨止点撕脱骨折_《中国修复重建外科杂志》

作者：

王穗源 , 肖扬 , 童作明 , 李贵求 , 蒋聚华 , 姚京辉 , 吴志勇 , 李腾飞 , 伍群

南华大学附属娄底市中心医院骨科（湖南娄底，417000）;

关键词：

前交叉韧带，胫骨止点撕脱骨折，关节镜，不可吸收缝线，微型钢板

DOI：

10.7507/1002-1892.20130227

视频：

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目的探讨关节镜下不可吸收缝线联合微型钢板固定治疗前交叉韧带（anterior cruciate ligament，ACL）胫骨止点撕脱骨折的方法及疗效。方法2009年1月－2012年3月，收治32例ACL胫骨止点撕脱骨折患者。男18例，女14例；年龄12～40岁，平均17.5岁。致伤原因：交通事故伤15例，运动伤6例，摔伤11例。受伤至手术时间为7～18 d，平均9.5 d。Lachman试验均为阳性。膝关节Lysholm 评分为（52.13 ± 4.22）分，国际膝关节文献委员会（IKDC）评分为（44.82 ± 2.44）分。按照Meyers-McKeever分型标准：Ⅱ型12例，Ⅲ型20例。关节镜辅助下骨折撬拨复位后，采用Ethibond不可吸收缝线绕行呈“八”字形的两胫骨隧道并掌指骨微型钢板悬吊固定。结果术后切口均Ⅰ期愈合，无关节感染、皮肤坏死等并发症发生。患者均获随访，随访时间12～50个月，平均22.4个月。术后12周患膝关节Lachman试验均为阴性。末次随访时，3例遗留膝关节伸直受限，其余患者伸膝范围均正常；屈膝范围均正常。Lysholm 评分为（94.19 ± 0.93）分，IKDC评分为（94.35 ± 1.22）分，均较术前显著提高，比较差异有统计学意义（t=55.080，P=0.000；t=101.715，P=0.000）。结论关节镜下不可吸收缝线联合微型钢板固定治疗ACL胫骨止点撕脱骨折具有手术创伤小、固定牢固、操作简便的优点，术后患者膝关节功能恢复良好。

引用本文： 王穗源,肖扬,童作明,李贵求,蒋聚华,姚京辉,吴志勇,李腾飞,伍群. 关节镜下不可吸收缝线联合微型钢板固定治疗前交叉韧带胫骨止点撕脱骨折. 中国修复重建外科杂志, 2013, 27(9): 1041-1044. doi: 10.7507/1002-1892.20130227 复制

1.	Shelbourne KD, Urch SE, Freeman H. Outcomes after arthroscopic excision of the bony prominence in the treatment of tibial spine avulsion fractures. Arthroscopy, 2011, 27(6): 784-791.
2.	Sharma A, Lakshmanan P, Peehal J, et al. An analysis of different types of surgical fixation for avulsion fractures of the anterior tibial spine. Acta Orthop Belg, 2008, 74(1): 90-97.
3.	Meyers MH, McKeever FM. Fracture of the intercondylar eminence of the tibia. J Bone Joint Surg (Am), 1970, 52(8): 1677-1684.
4.	Johnson DL, Durbin TC. Physeal-sparing tibial eminence fracture fixation with a headless compression screw. Orthopedics, 2012, 35(7): 604-608.
5.	Cloclaerts S, Dossche L. Combined arthroscopic techniques in the treatment of non-union of the anterior tibial spine. Acta Orthop Belg, 2011, 77(3): 394-397.
6.	Liljeros K, Werner S, Janarv PM. Arthroscopic fixation of anterior tibial spine fractures with bioabsorbable nails in skeletally immature patients. Am J Sports Med, 2009, 37(5): 923-928.
7.	Bonin N, Jeunet L, Obert L, et al. Adult tibial eminence fracture fixation: arthroscopic procedure using K-wire folded fixation. Knee Surg Sports Traumatol Arthrosc, 2007, 15(7): 857-862.
8.	Huang TW, Hsu KY, Cheng CY, et al. Arthroscopic suture fixation of tibial eminence avulsion fractures. Arthroscopy, 2008, 24(11): 1232-1238.
9.	Mahar AT, Duncan D, Oka R, et al. Biomechanical comparison of four different fixation techniques for pediatric tibial eminence avulsion fractures. J Pediatr Orthop, 2008, 28(2): 159-162.
10.	Su WR, Wang PH, Wang HN, et al. A simple, modified arthroscopic suture fixation of avulsion fracture of the tibial intercondylar eminence in children. J Pediatr Orthop B, 2011, 20(1): 17-21.
11.	Fabricant PD, Osbahr DC, Green DW. Management of a rare complication after screw fixation of a pediatric tibial spine avulsion fracture: a case report with follow-up to skeletal maturity. J Orthop Trauma, 2011, 25(12): e115-e119.
12.	Kocher MS, Saxon HS, Hovis WD, et al. Management and complications of anterior cruciate ligament injuries in skeletally immature patients: survey of the Herodicus Society and The ACL Study Group. J Pediatr Orthop, 2002, 22(4): 452-457.
13.	Eggers AK, Beeker C, Weimann A, et al. Biomechanical evaluation of different fixation methods for tibial eminence fractures. Am J Sports Med, 2007, 35(3): 404-410.
14.	赵金忠, 蒋垚, 沈灏, 等. 关节镜下8字法缝线固定治疗成人胫骨髁间隆突骨折. 中国修复重建外科杂志, 2003, 17(3): 205-208.
15.	Park HJ, Urabe K, Naruse K, et al. Arthroscopic evaluation after surgical repair of intercondylar eminence fractures. Arch Orthop Trauma Surg, 2007, 127(9): 753-757.
16.	Wang J, Ao Y. Analysis of different kinds of cyclops lesions with or without extension loss. Arthroscopy, 2009, 25(6): 626-631.
17.	Kambhampati S, Ware H. Inverted cyclops lesion after anterior cruciate ligament reconstruction. Ann R Coll Surg Engl, 2012, 94(2): e99-100.

1. Shelbourne KD, Urch SE, Freeman H. Outcomes after arthroscopic excision of the bony prominence in the treatment of tibial spine avulsion fractures. Arthroscopy, 2011, 27(6): 784-791.
2. Sharma A, Lakshmanan P, Peehal J, et al. An analysis of different types of surgical fixation for avulsion fractures of the anterior tibial spine. Acta Orthop Belg, 2008, 74(1): 90-97.
3. Meyers MH, McKeever FM. Fracture of the intercondylar eminence of the tibia. J Bone Joint Surg (Am), 1970, 52(8): 1677-1684.
4. Johnson DL, Durbin TC. Physeal-sparing tibial eminence fracture fixation with a headless compression screw. Orthopedics, 2012, 35(7): 604-608.
5. Cloclaerts S, Dossche L. Combined arthroscopic techniques in the treatment of non-union of the anterior tibial spine. Acta Orthop Belg, 2011, 77(3): 394-397.
6. Liljeros K, Werner S, Janarv PM. Arthroscopic fixation of anterior tibial spine fractures with bioabsorbable nails in skeletally immature patients. Am J Sports Med, 2009, 37(5): 923-928.
7. Bonin N, Jeunet L, Obert L, et al. Adult tibial eminence fracture fixation: arthroscopic procedure using K-wire folded fixation. Knee Surg Sports Traumatol Arthrosc, 2007, 15(7): 857-862.
8. Huang TW, Hsu KY, Cheng CY, et al. Arthroscopic suture fixation of tibial eminence avulsion fractures. Arthroscopy, 2008, 24(11): 1232-1238.
9. Mahar AT, Duncan D, Oka R, et al. Biomechanical comparison of four different fixation techniques for pediatric tibial eminence avulsion fractures. J Pediatr Orthop, 2008, 28(2): 159-162.
10. Su WR, Wang PH, Wang HN, et al. A simple, modified arthroscopic suture fixation of avulsion fracture of the tibial intercondylar eminence in children. J Pediatr Orthop B, 2011, 20(1): 17-21.
11. Fabricant PD, Osbahr DC, Green DW. Management of a rare complication after screw fixation of a pediatric tibial spine avulsion fracture: a case report with follow-up to skeletal maturity. J Orthop Trauma, 2011, 25(12): e115-e119.
12. Kocher MS, Saxon HS, Hovis WD, et al. Management and complications of anterior cruciate ligament injuries in skeletally immature patients: survey of the Herodicus Society and The ACL Study Group. J Pediatr Orthop, 2002, 22(4): 452-457.
13. Eggers AK, Beeker C, Weimann A, et al. Biomechanical evaluation of different fixation methods for tibial eminence fractures. Am J Sports Med, 2007, 35(3): 404-410.
14. 赵金忠, 蒋垚, 沈灏, 等. 关节镜下8字法缝线固定治疗成人胫骨髁间隆突骨折. 中国修复重建外科杂志, 2003, 17(3): 205-208.
15. Park HJ, Urabe K, Naruse K, et al. Arthroscopic evaluation after surgical repair of intercondylar eminence fractures. Arch Orthop Trauma Surg, 2007, 127(9): 753-757.
16. Wang J, Ao Y. Analysis of different kinds of cyclops lesions with or without extension loss. Arthroscopy, 2009, 25(6): 626-631.
17. Kambhampati S, Ware H. Inverted cyclops lesion after anterior cruciate ligament reconstruction. Ann R Coll Surg Engl, 2012, 94(2): e99-100.

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《中国修复重建外科杂志》

关节镜下不可吸收缝线联合微型钢板固定治疗前交叉韧带胫骨止点撕脱骨折

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