摘要
目的探讨应用改良的关节镜下带垫片的空心螺钉内固定技术治疗儿童膝关节前交叉韧带（anterior cruciate ligament，ACL）胫骨止点撕脱性骨折的术后5年疗效。方法2000年3月至2003年11月，应用改良关节镜下带垫片的空心螺钉内固定技术治疗骨骺未闭合的儿童ACL胫骨止点撕脱性骨折39例。全部患者术后定期摄正侧位x线平片以判定骨折愈合情况。术后随访5年以上的患者采用膝关节Lysholm和Tegner评分以评价术前、术后伤膝功能，临床查体结合正侧位摄片检查有无肢体短缩或成角畸形，并行KT-2000测试以检测伤膝关节稳定性。结果经X线摄片证实骨折满意愈合后，39例患者于术后3～6个月返院行关节镜手术摘除了内植物，其中31例获得了5年以上随访。该组患者未发现伤肢肢体短缩或成角畸形，亦无伤膝不稳的主诉。术前Lysholm评分为12～48（19．2±14．8）分，术后5年的Lysholm评分为97～100（98．5±3．1）分（t=18．40，P〈0．01），术前Tegner评分为3～5（4．1±1．1）分，术后5年Tegner评分为7～9（8．54±0．8）分（t=4．13，P〈0．01）。14名患者的KT-2000测试（手动模式）提示患／健侧胫骨前向位移之差大于2mm（2．1～3．8mm），其临床查体亦证实Lachman试验阳性。结论关节镜下应用带垫片的空心螺钉治疗骨骺未闭合儿童ACL胫骨止点撕脱性骨折的改良技术是简便、安全、可靠的ARIF手术方法，不会影响伤肢的生长发育。
Objective To cruciate ligament from the tibial evaluate more than 5-year follow-up outcome of avulsion fracture of the anterior insertion site in skeletally immature patients treated with modified arthroscopic internal fixation with cannulated screw and washer. Methods Thirty-nine patients with open physis were treated by modified arthroscopic internal fixation with cannulated screw and washer from March 2000 to November 2003. Regular X-ray plain films at AP and lateral views were conducted to detect the healing of avulsed fragments. Follow-up period of 31 patients was more than 5 years. Functional outcome before and after surgery was evaluated using the Lysholm Knee Score and the Tegner Activity Score. Angular deformity, or leg length discrepancy was assessed by clinical examination and anteroposterior-lateral radiographs of the knee. Instrumented knee laxity was performed using the KT-2000 arthrometer. Results Arthroscopic removal of implants was performed between 3 and 6 months postoperatively, when all fractures were revealed to have healed on X-ray films. No growth disturbance, angular deformation or knee instability was found in 31 patients during more than 5-year follow-up. The Lysholm score was improved from （19.2 ± 14.8 ） （range 12 -48） preoperatively to （98.5 ± 3.1 ） （range 97 - 100） postoperatively, with significant statistical difference by the student-t test （t=18. 395, P = 0.000） ; The Tegner score was improved from （4.1 ± 1.1 ） （ range 3 - 5 ） preoperatively to （8.5 ＋ 0.8 ） （range 7 - 9 ） postoperatively, with significant statistical difference by the student-t test （ t = 4. 13, P = 0. 008）. Physical examination showed Lachman test （ ＋ ） in 14 of 31 patients. Instrumented knee laxity （ KT- 2000） Showed manual-maximum side-to-side difference greater than 2 mm （range 2.1 -3.8 ram） in 14 of 31 patients. Conclusion Modified arthroscopic internal fixation of avulsion fracture of the anterior cruciate ligament from the tihial insertion site with cannulated screw and washer in skeletally immature patients is a simple, safe, and effective ARIF procedure without growth disturbance.
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2008年第15期1424-1426,共3页
Journal of Third Military Medical University
关键词
前交叉韧带
撕脱骨折
开放骺板
关节镜
anterior cruciate ligament
avulsion fracture
open physis
arthroscopy
