关节镜下缝线桥技术治疗前交叉韧带胫骨止点撕脱骨折疗效分析

Effectiveness of arthroscopic treatment of anterior cruciate ligament tibial eminence avulsion fracture with suture bridge fixation technique

摘要:

目的 探讨关节镜下采用缝线桥技术治疗前交叉韧带（ACL）止点撕脱骨折的手术方法以及评价术后疗效。方法 2013年5月-2015年7月，收治18例ACL止点撕脱骨折患者，均采用关节镜下缝线桥技术予以复位固定，男12例，女6例，年龄9～45岁，平均29.8岁，右膝10例，左膝8例。致伤原因：运动伤5例，交通事故伤10例，其他3例。陈旧性骨折2例，余均为新鲜骨折。术前患者均有前抽屉试验以及Lachman试验（+），国际膝关节评分委员会（IKDC）主观评分为（53.8±4.2）分。按照Meyers-Mckeaver分型标准：Ⅱ型5例，Ⅲ型10例，Ⅳ型3例。结果 手术时间50～80 min，平均60.5 min。术后患者切口均Ⅰ期愈合，术后复查X线片均示骨折复位满意。18例患者均获得随访，随访时间6～31个月，平均18.6个月，术后末次随访，17例患者Lachman试验以及前抽屉试验均阴性，1例前抽屉试验阴性，Lachman试验弱阳性，IKDC膝关节主观评分为（95.2±3.8）分，与术前比较差异有统计学意义（P <0.05）。结论 关节镜下采用缝线桥技术治疗ACL止点撕脱骨折手术方法操作简便，可取得良好复位，牢固固定，具有创伤小和适应证广泛等优势。同时允许患者早期开始功能锻炼。

Abstract:

Objective To evaluate the technique and clinical effect of arthroscopic treatment of anterior cruciate ligament tibial eminence avulsion fracture with suture bridge fixation technique. Methods From May 2013 to July 2015, 18 patients with anterior cruciate ligament tibial eminence avulsion fracture were treated with arthroscopic reduction and fixation by suture bridge technique. There were 12 males and 6 females with an average age of 29.8 years old (range, 9 ～ 45 years). The right knees were involved in 10 cases and left knees in 8 cases. The injury causes included traffic accident injury in 10 cases, sports injury in 5 cases and other reasons in 3 cases. 2 patients had old fracture, the others had fresh fracture. The results of Lachman and anterior drawer test were both positive. The International Knee Documentation Committee (IKDC) subject score was (53.8 ± 4.2). Based on Meyers-Mckeaver classification, there were 5 cases in typeⅡ, 10 cases in type Ⅲ and 3 cases in type Ⅳ. Results The operation time was 50～80 minutes (mean, 60.5 minutes), X-ray showed satisfactory fracture reduction after surgery. Primary healing of incision were obtained with no infection, all 18 patients were followed up for 6 ～ 31 months (mean, 18.6 months). The results of Lachman and anterior drawer test were both negative in 17 cases, the result was negative for anterior drawer test and was weakly positive for Lachamn test in 1 case. The IKDC subject score were significantly improved to (95.2 ± 3.8) at last follow-up (P < 0.05). Conclusion It could achieve early restoration of knee joint function to treat the anterior cruciate ligament tibial eminence avulsion fracture with suture bridge fixation technique because of satisfactory reduction, reliable fixation, minor trauma, and quick recovery.