关节镜下可吸收螺钉治疗前交叉韧带 胫骨止点撕脱性骨折

Arothroscopic treatment of anterior cruciate ligament tibial avulsion using absorble screws

摘要:

目的 探讨关节镜下可吸收螺钉治疗前交叉韧带胫骨止点撕脱性骨折的方法及临床疗效。方法 2010年1月~2011年12月，对15例前交叉韧带胫骨止点撕脱性骨折患者于关节镜下进行骨折复位，并应用可吸收螺钉进行骨折固定。前抽屉试验及Lachman试验均呈阳性，Lysholm评分为（42.1±5.7）分，国际膝关节文献委员会（IKDC）2000主观膝关节评分为（43.2±5.3）分。结果 患者均获随访，随访时间3～12个月，平均9.1个月。术后即刻X线片检查示前交叉韧带胫骨止点撕脱性骨折复位良好，术后3个月X线片复查示前交叉韧带胫骨止点撕脱性骨折均愈合。末次随访时，患肢膝关节活动范围达0～120°；除2例Lachman试验阴性、前抽屉试验弱阳性外，其余10例两项检查均呈阴性；Lysholm评分为（89.7±3.1）分，与术前比较差异有显著性（t =21.800，P =0.000）；IKDC2000主观膝关节评分为（93.5±6.4）分，与术前比较差异有显著性（t =21.700，P =0.000）。结论 关节镜下可吸收螺钉治疗前交叉韧带胫骨止点撕脱性骨折，能实现有效复位、牢固固定以及骨折临床愈合，具有简单易行、固定准确牢固及无需二次手术等优点。

Abstract:

【Objective】 To investigate the outcomes of arthroscopic reduction and internal fixation using absorbable screws. 【Methods】 Between January 2010 and December 2011, 15 patients with anterior cruciate ligament tibial avulsion fractures were treated with arthroscopic reduction and fixation using absorbable screws. There were 12 males and 3 females with an average age of 28.1years(range, 17~42years). The results of the anterior drawer test and Lachman test were positive. The mean Lysholm score was（42.1±5.7）, The Inter national knee Documentation Committee(IKDC) 2000 subject score was (43.2±5.3). 【Results】 All the patients were followed up 9.1 months (range, 3~12 months). The X-ray films showed good reduction of fracture immediately after operation and fracture healing at 3 months. At the last follow-up, the range of motion of knee was 0-130°. The results of Lachman test and anterior drawer test were negative in 10 cases; and the results of anterior drawer test were weakly positive in 2 cases. The mean Lysholm score was significantly improved (89.1±3.1) postoperatively (t =21.800, P=0.000). The Inter national knee Documentation Committee (IKDC) 2000 subject score improved to(93.5±6.4) postoperatively(t=21.700, P=0.000). 【Conclusion】 Arthroscopic treatment using absorbable double suture anchors for tibial eminence avulsion fracture can provide satisfactory reduction, stable fixation, and good healing of the avulsed fragment, which is a minimally-invasive, simple, and effective treatment for patients with tibial eminence avulsion fracture.