关节镜下带襻钢板治疗前交叉韧带胫骨止点撕脱骨折的疗效分析
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摘要
目的探讨关节镜下带襻钢板治疗膝关节前交叉韧带胫骨止点撕脱骨折的疗效。方法 2015年6月~2017年1月我科对20例前交叉韧带胫骨止点撕脱骨折在关节镜下行骨折复位固定术:经前交叉韧带定位器定位撕脱骨块,建立胫骨隧道,通过引线把带襻钢板拉入关节腔,固定线拉出胫骨隧道外口,镜下调整钢板位置,覆盖骨块,随后拉紧固定线,在胫骨隧道外穿入另一块带襻钢板,在其表面打结,形成悬吊固定。术后定期随访,了解骨折复位愈合情况并评估膝关节功能。结果手术时间50~100 min,平均61.4 min。20例随访6~21个月,平均16.5月。术后5个月复查X线片,均骨折复位满意,愈合良好;末次随访Lachman和前抽屉试验均阴性,Lysholm膝关节功能评分85~98分,平均95.5分。结论关节镜下带襻钢板治疗膝关节前交叉韧带胫骨止点撕脱骨折具有创伤小、固定可靠、预后良好等优点,值得推广。
Objective To discuss the curative effect of arthroscopic internal fixation with EndoButton in the treatment of tibial avulsion fracture of anterior cruciate ligament. Methods From June 2015 to January 2017,20 cases of tibial avulsion fracture of anterior cruciate ligament were treated with EndoButton fixation under knee arthroscopy. The avulsion bone was located with anterior cruciate ligamentum locator. A tibial tunnel was established. An EndoButton was introduced into the joint cavity via a guidewire and the fixation wire was pulled out of the external opening of the tibial tunnel. After adjustment of the plate,the bone was covered and the fixation wire was tightened. Another EndoButton was inserted outside of the tibial tunnel and was knotted on its surface for suspension fixation. Postoperative follow-ups were carried out to observe the reduction and healing of the avulsion fractures and to evaluate the functional recovery of the knee. Results The operation time was 50-100 min( mean,61. 4 min). All the patients were followed up for 6-21 months( mean,16. 5 months). All the patients acquired bony union without fragments displacement at 5 months after operation under X-ray examinations. The results of Lachman test and anterior drawer test were both negative in all the cases at the last follow-up. The Lysholm scores were 85-98 points( mean,95. 5 points) at the last follow-up. Conclusion Arthroscopic internal fixation with EndoButton in the treatment of tibial avulsion fracture of anterior cruciate ligament has advantages of little invasion,reliable fixation and favorable prognosis,which is worthy of being promoted.
Objective To discuss the curative effect of arthroscopic internal fixation with EndoButton in the treatment of tibial avulsion fracture of anterior cruciate ligament. Methods From June 2015 to January 2017,20 cases of tibial avulsion fracture of anterior cruciate ligament were treated with EndoButton fixation under knee arthroscopy. The avulsion bone was located with anterior cruciate ligamentum locator. A tibial tunnel was established. An EndoButton was introduced into the joint cavity via a guidewire and the fixation wire was pulled out of the external opening of the tibial tunnel. After adjustment of the plate,the bone was covered and the fixation wire was tightened. Another EndoButton was inserted outside of the tibial tunnel and was knotted on its surface for suspension fixation. Postoperative follow-ups were carried out to observe the reduction and healing of the avulsion fractures and to evaluate the functional recovery of the knee. Results The operation time was 50-100 min( mean,61. 4 min). All the patients were followed up for 6-21 months( mean,16. 5 months). All the patients acquired bony union without fragments displacement at 5 months after operation under X-ray examinations. The results of Lachman test and anterior drawer test were both negative in all the cases at the last follow-up. The Lysholm scores were 85-98 points( mean,95. 5 points) at the last follow-up. Conclusion Arthroscopic internal fixation with EndoButton in the treatment of tibial avulsion fracture of anterior cruciate ligament has advantages of little invasion,reliable fixation and favorable prognosis,which is worthy of being promoted.
引文
1 White EA,Patel DB,Matcuk GR,et al.Cruciate ligament avulsion fractures:anatomy,biomechanics,injury patterns,and approach to management.Emerg Radiol,2013,20(5):429-440.
2 Enderle E,Frosch KH.Arthroscopy-assisted management of knee fractures.Unfallchirurg,2013,116(4):311-317.
3 Meyers MH,Mc Keever FM.Fracture of the intercondylar eminence of the tibia.J Bone Joint Surg Am,1970,52(8):1677-1684.
4 Bley JA,Pomajzl RJ,Smith PA.Knotless arthroscopic reduction and internal fixation of a displaced anterior cruciate ligament tibial eminence avulsion fracture.Am J Orthop(Belle Mead NJ),2017,46(4):203-208.
5 Frank JS,Gambacorta PL.Anterior cruciate ligament injuries in the skeletally immature athlete:diagnosis and management.J Am Acad Orthop Surg,2013,21(2):78-87.
6 Boutsiadis A,Karataglis D,Agathangelidis F,et al.Arthroscopic4 -point suture fixation of anterior cruciate ligament tibial avulsion fractures.Arthrosc Tech,2014,3(6):e683-e687.
7 吕宏升,杨德育,杨爱武,等.关节镜下应用微型钢板治疗陈旧性前交叉韧带胫骨止点撕脱骨折.中国微创外科杂志,2016,16(3):266-270.
8 Lehman RA Jr,Murphy KP,Machen MS,et al.Modified arthroscopic suture fixation of a displaced tibial eminence fracture.Arthroscopy,2003,19(2):E6.
9 张军,徐荣明,查卫斌,等.3种方法手术治疗前交叉韧带胫骨止点撕脱骨折的临床疗效分析.中国骨与关节损伤杂志,2017,32(10):1077-1078.
10 Ezechieli M,Schafer M,Becher C,et al.Biomechanical comparison of different fixation techniques for reconstruction of tibial avulsion fractures of the anterior cruciate ligament.Int Orthop,2013,37(5):919-923.
11 卢华定,史德海,董云旭,等.关节镜下钢丝固定治疗前交叉韧带胫骨止点撕脱骨折.中国骨与关节损伤杂志,2011,26(2):112-114.
12 Seon JK,Park SJ,Lee KB,et al.A clinical comparison of screw and suture fixation of anterior cruciate ligament tibial avulsion fractures.Am J Sports Med,2009,37(12):2334-2339.
13 孙伟,张鹏,刘泽淼,等.关节镜下经髌内侧入路空心钉固定治疗前交叉韧带胫骨止点撕脱骨折.中国运动医学杂志,2013,32(2):108-111,141.
14 朱爱平,程国林,李继春,等.关节镜下辅助复位结合空心钉内固定治疗前交叉韧带胫骨止点撕脱骨折.中国骨与关节损伤杂志,2013,28(10):965-966.
15 Sekiya H,Takatoku K,Kimura A,et al.Arthroscopic fixation with EndoButton fortibial eminence fractures visualised through a proximal superomedial portal:asurgical technique.J Orthop Surg(Hong Kong),2016,24(3):417-420.
16 周江,丁聪,刘建新,等.经关节镜纽扣钢板治疗膝关节前交叉韧带胫骨止点撕脱骨折19例.右江民族医学院学报,2010,32(2):191-192.
2 Enderle E,Frosch KH.Arthroscopy-assisted management of knee fractures.Unfallchirurg,2013,116(4):311-317.
3 Meyers MH,Mc Keever FM.Fracture of the intercondylar eminence of the tibia.J Bone Joint Surg Am,1970,52(8):1677-1684.
4 Bley JA,Pomajzl RJ,Smith PA.Knotless arthroscopic reduction and internal fixation of a displaced anterior cruciate ligament tibial eminence avulsion fracture.Am J Orthop(Belle Mead NJ),2017,46(4):203-208.
5 Frank JS,Gambacorta PL.Anterior cruciate ligament injuries in the skeletally immature athlete:diagnosis and management.J Am Acad Orthop Surg,2013,21(2):78-87.
6 Boutsiadis A,Karataglis D,Agathangelidis F,et al.Arthroscopic4 -point suture fixation of anterior cruciate ligament tibial avulsion fractures.Arthrosc Tech,2014,3(6):e683-e687.
7 吕宏升,杨德育,杨爱武,等.关节镜下应用微型钢板治疗陈旧性前交叉韧带胫骨止点撕脱骨折.中国微创外科杂志,2016,16(3):266-270.
8 Lehman RA Jr,Murphy KP,Machen MS,et al.Modified arthroscopic suture fixation of a displaced tibial eminence fracture.Arthroscopy,2003,19(2):E6.
9 张军,徐荣明,查卫斌,等.3种方法手术治疗前交叉韧带胫骨止点撕脱骨折的临床疗效分析.中国骨与关节损伤杂志,2017,32(10):1077-1078.
10 Ezechieli M,Schafer M,Becher C,et al.Biomechanical comparison of different fixation techniques for reconstruction of tibial avulsion fractures of the anterior cruciate ligament.Int Orthop,2013,37(5):919-923.
11 卢华定,史德海,董云旭,等.关节镜下钢丝固定治疗前交叉韧带胫骨止点撕脱骨折.中国骨与关节损伤杂志,2011,26(2):112-114.
12 Seon JK,Park SJ,Lee KB,et al.A clinical comparison of screw and suture fixation of anterior cruciate ligament tibial avulsion fractures.Am J Sports Med,2009,37(12):2334-2339.
13 孙伟,张鹏,刘泽淼,等.关节镜下经髌内侧入路空心钉固定治疗前交叉韧带胫骨止点撕脱骨折.中国运动医学杂志,2013,32(2):108-111,141.
14 朱爱平,程国林,李继春,等.关节镜下辅助复位结合空心钉内固定治疗前交叉韧带胫骨止点撕脱骨折.中国骨与关节损伤杂志,2013,28(10):965-966.
15 Sekiya H,Takatoku K,Kimura A,et al.Arthroscopic fixation with EndoButton fortibial eminence fractures visualised through a proximal superomedial portal:asurgical technique.J Orthop Surg(Hong Kong),2016,24(3):417-420.
16 周江,丁聪,刘建新,等.经关节镜纽扣钢板治疗膝关节前交叉韧带胫骨止点撕脱骨折19例.右江民族医学院学报,2010,32(2):191-192.
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