镜下三线交联拉出固定前交叉韧带胫骨止点撕脱骨折

Pullout of a three- suture net in arthroscopic fixation of anterior cruciate ligament tibial avulsion fractures

摘要:

［目的］介绍镜下三线交联拔出固定前交叉韧带（anterior cruciate ligament, ACL）胫骨止点撕脱骨折的手术技术和初步临床效果。［方法］2016 年 1 月—2018 年 6 月 36 例 ACL 胫骨止点撕脱骨折（Meyer-McKeevers 分型Ⅱ~Ⅳ型）患者采用上述术式治疗。通过标准前外侧入口进行全面关节镜检查后，将带 PDS 缝线的腰椎穿刺针穿过 ACL 胫骨附着基底的前 1/2，引入第 1 根 Ethibond 2 号线，穿过膝关节横韧带下的两端，皮下到达胫骨前内侧。分别从胫骨前内侧至骨折前内、外侧缘钻孔 2 个骨隧道后，将第 2 根 Ethibond 2 号缝线穿过一侧隧道、ACL 胫骨附着基底后 1/2 和另一侧骨隧道。然后，在止点的第 1 根缝线上引入第 3 根缝线。最后，将 3 根缝合线全部拉紧，再像网一样扎紧，复位并固定骨折块。［结果］ 所有患者均顺利完成手术， 未见围手术期相关并发症及伤口感染情况。末次随访，Lysholm 评分、IKDC 主观评分、中位 Tegner 活动水平量表均显著增加 （P<0.05）。影像方面，骨折复位较好、固定牢靠，骨折临床愈合时间 12~16 周。［结论］镜下三线交联拔出在直视下行 ACL 胫骨止点撕脱骨折复位固定，操作简单安全，术后膝关节功能恢复好。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical results of pullout of a three-suture net used in ar- throscopic fixation of anterior cruciate ligament (ACL) tibial avulsion fractures. [Methods] A total of 36 patients received abovementioned arthroscopic treatment for Meyer-McKeevers tye II~IV ACL tibial avulsion fractures in our hospital from January 2016 to June 2018. After a thorough arthroscopic examination through the standard anterolateral approach, a lumbar puncture needle with PDS suture was introduced crossed the anterior 1/2 of the tibial attachment base of the ACL. The first Ethibond No.2 wire was replaced and pass the ends under the transverse knee ligament to anteromedial tibial subcutaneously. After two bone tunnels were respectively drilled from the anteromedial tibi- al side to the anteromedial and anterolateral margins of the fractures, the second Ethibond No.2 wire was passed through one side tunnel, the posterior 1/2 of the tibial attachment base of the ACL and the other side bone tunnel. Then, the third suture was introduced on the first suture in the attachment. Finally, all the 3 sutures were pull out tightly, and then tied to reduce and fasten the fracture fragments firmly like a net. [Results] All patients got the operation completed successfully without related complications and infection. At last follow- up, the Lysholm, IKDC, and Tegner scores were significantly increased compared with those preoperatively (P＜0.05) . In terms of imaging, all the patients gained proper fracture reduction with fracture healing time of 12~16 weeks. [Conclusion] This arthroscopic three-suture net fixa- tion does achieve satisfactory clinical outcomes for ACL tibial avulsion fractures. with advantages of simple operation and high safety.