关节镜下钢丝与空心螺钉固定治疗胫骨髁间棘骨折的临床疗效

A retrospective cohort study of steel wire and hollow screw fixation for tibial intercondylar crest fractures under arthroscopy

摘要:

目的 探讨关节镜下钢丝固定及空心金属螺钉治疗胫骨髁间棘骨折的疗效。方法 回顾性分析2014年10月－2020年3月南阳市骨科医院运动医学科收治的70例髁间棘骨折患者的临床资料。其中，驾驶两轮电动车摔倒受伤45例，平地行走滑倒或绊倒7例，高处坠落伤7例，运动损伤3例，交通事故4例，其他4例。根据不同手术方式将患者分为钢丝固定组（n = 49）及空心螺钉固定组（n = 21）。钢丝固定组采用关节镜下钢丝固定治疗胫骨髁间棘骨折，空心螺钉固定组采用空心加压螺钉固定治疗胫骨髁间棘骨折。钢丝固定组中，男24例，女25例；年龄10～58岁，平均（30.76±13.53）岁；左膝29例，右膝20例。空心螺钉固定组中，男11例，女10例；年龄16～51岁，平均（31.90±11.02）岁；左膝13例，右膝8例。结果 所有患者术后随访1年，均骨性愈合，无感染、移位、钢丝断裂、骨骺畸形愈合和关节粘连发生。钢丝固定组术前Lysholm评分为（51.61±2.83）分，术后6个月为（96.78±1.85）分；空心螺钉固定组术前Lysholm评分为（51.52±3.04）分，术后6个月为（96.52±1.91）分，两组患者术前和术后6个月Lysholm评分比较，差异均无统计学意义（P > 0.05）。钢丝固定组手术时间为（76.76 ±11.57）min，明显短于空心螺钉固定组的（98.62±14.37）min，差异有统计学意义（P < 0.05）。钢丝固定组住院天数为（10.94±0.94）d，空心螺钉固定组为（10.62±1.07）d，差异无统计学意义（P > 0.05）。钢丝固定组住院费用为（8 964.18±271.04）元，明显少于空心螺钉固定组的（11 276.95±522.64）元，差异有统计学意义（P < 0.05）。结论 髁间棘骨折为常见的膝关节内骨折，均应早期行关节镜下复位内固定，使用钢丝或空心加压螺钉内固定均可。钢丝固定技术手术时间短，住院费用低，且内植物取出方便，应为优先选择。

Abstract:

Objective To discuss the effect and method of arthroscopic treatment of tibial intercondylar eminence fracture using steel wire or hollow metal screw.Methods 70 patients with tibial intercondylar eminence fracture were treated by arthroscopic fixation with steel wire or hollow metal screw from October 2014 to March 2020, concluding 45 cases of electric bicycle related injury, 7 cases of slip, 7 cases of fall injury, 3 cases of sport injury, 4 cases of traffic injury and 4 others. The patients were divided into steel wire fixation group (n = 49) and hollow screw fixation group (n = 21) according to the operation method. The patients in the wire fixation group were treated with steel wire, the fractures were fixed with hollow screw in the hollow screw fixation group. There were 24 males and 25 females in the wire fixation group, the average age was (30.76 ± 13.53) years (range 10 ~ 58 years), there were 29 cases of left knee and 20 cases of right knee, There were 11 males and 10 females in the hollow screw fixation group, the average age was (31.90 ± 11.02) years (range, 16 ~ 51 years), there were 13 cases of left knee and 8 cases of right knee.Results All the patients were followed up for 1 year after operation, and bone healed without infection, displacement, wire fracture, epiphyseal malunion and joint adhesion. The Lysholm score of wire fixation group was (51.61 ± 2.83) before operation, and (96.78 ± 1.85) 6 months after operation. The Lysholm score of hollow screw fixation group was (51.52 ± 3.04) before operation, and (96.52 ± 1.91) 6 months after operation, there was no significant difference between the two groups before operation and 6 months after operation (P > 0.05). The operation time of wire fixation group was (76.76 ± 11.57) min, which was significantly shorter than that of hollow screw fixation group (98.62 ± 14.37) min, and the difference was statistically significant (P < 0.05). The length of hospital stay was (10.94 ± 0.94) d in the wire fixation group and (10.62 ± 1.07) d in the hollow screw fixation group, and the difference was not statistically significant (P > 0.05). The hospitalization cost of wire fixation group was (8 964.18 ± 271.04) yuan, which was significantly lower than that of hollow screw fixation group (11 276.95 ± 522.64) yuan, the difference was statistically significant (P < 0.05).Conclusion Intercondylar eminence fracture is a common intra-knee fracture and should be fixed with arthroscope earlier, either with steel wire or hollow compression screw. The steel wire method should be preferred because of its short operation time, low hospitalization cost and convenience of taking out.