摘要
目的观察关节镜下前交叉韧带(ACL)胫骨止点撕脱性骨折移位的病理解剖与手术技术选择的关系。方法对23例ACL胫骨止点撕脱性骨折行关节镜下观察,明确骨折移位情况及骨折端难以手术复位的原因。采用在关节镜下结合常规关节镜入路和经髌腱入路进行骨折复位固定。使用双根5号Ethibond聚乙烯缝线将ACL环绕,缝合线引到胫骨平台下打结并结合空心钉固定打结线。结果23例撕脱骨折面均不平整,骨折两端间存留碎骨片及血凝块嵌入16例、膝横韧带嵌入7例、髌下滑膜嵌入4例、内侧半月板前角嵌入5例。14例Ⅲ型骨折中13例撕脱骨折块除与ACL相连外,还与外侧半月板前角相连,骨块向上外明显移位。手术时间40～60(50±6.46)min。23例均获随访,时间10～26(15±3.95)个月。术后3个月骨折均获愈合,未出现骨折移位。根据Lysholm膝关节功能评分:术前19～42(30.13±6.36)分;术后6个月90～98(93.91±2.56)分(t=49.92,P<0.01)。结论移位的ACL胫骨止点撕脱性骨折块不仅与ACL相连,而且绝大部分还与外侧半月板前角相连,两者力学作用方向不同是其难以复位的主要原因。关节镜下缝线8字打结空心钉固定治疗ACL胫骨止点撕脱性骨折疗效确切。
Objective To observe the anatomy of tibial eminence fractures and to choose of surgical treatment technique. Methods 23 patients underwent arthroscopic observations to find the reason which the fracture fragments were difficult to reduce. All cases were treated arthroscopically through rountine portal and through patellae ligament portal.The anterior cruciate ligament（ACL） and avulsion bone fragment were held figure-of-eight together with two Ethibond 5 polyester threads. The threads were pulled out through tibia tunnels and tighterned and fixed on cannulated screw and washer which under tibia tunnels 2 cm. Results In 23 cases of the fracture gaps,the fragments and blood clots were involved in the fracture in 16 cases,the transverse intermeniscal ligament were involved in the fracture in 7 cases,the synovial hypertrophy were involved in the fracture in 4 cases,and the anterior part of the medial meniscus was involved in 5 cases. A superiorly displaced fragment of the anterior tibial eminence was found in the intercondylar notch in 14 cases of type Ⅲ fractures.Attached to the fragment was not only the ACL but also,in 13 cases,the anterior horn of the lateral meniscus. The operation time were 40～60 （50±6.46）min. A follow-up check up was made in the 23 patients for 10～26（15±3.95） months. All fractures were united without displacement after three months. The Lysholm scores improved from a preoperative score of 19～42 （30.13±6.36） to 90～98（93.91±2.56） at follow-up （t=49.92,P〈0.01）. Conclusions The fracture fragment is diffcult to reduce as it is attached to two structures： the ACL and the anterior horn of the lateral meniscus,pulling in different directions. Arthroscopic figure-of-eight suture fixation with cannulated screw and washer for bony avulsion of the ACL technique is simple to perform and gives a satisfactory short-term results.
出处
《临床骨科杂志》
2009年第4期361-364,共4页
Journal of Clinical Orthopaedics
基金
南京军区医学科技创新课题(编号:08MA071)
