镜下改良双“8”字缝线固定II型胫骨棘撕脱骨折

Fixed type II tibial spine avulsion fracture with modified double "8" suture under arthroscopy

摘要:

［目的］ 探讨关节镜下改良双“8”字双隧道治疗Meyers-MckeeverⅡ型胫骨髁间嵴骨折的临床疗效。［方法］ 回顾性分析2015年10月—2020年5月应用关节镜下改良双“8”字双隧道治疗Meyers-MckeeverⅡ型胫骨髁间嵴骨折17例，男13例，女4例；年龄14～49岁，平均年龄（29.59±8.34）岁；均为单侧损伤（右侧12例，左侧5例）。总结17例患者术前、术后3个月、术后１年的膝关节伸屈ROM、VAS评分、Lyshol评分和IKDC评分评估患者膝关节功能恢复情况；检查前抽屉试验、Lachman试验、轴移试验评估患者膝关节稳定性。［结果］ 17例患者随访9～36个月，平均随访时间（18.53±6.90）个月；手术时间40～49min，平均手术时间（45.94±2.93）min；均在术后10～12周内达到骨性愈合，平均骨折愈合时间（11.24±0.75）周；术后3个月、１年的膝关节伸屈ROM、VAS评分、Lyshol评分和IKDC评分分别为 [（102.18±3.76）、（124.06±0.97）°]、 [（2.29±0.47）、（0.94±0.66）分] 、 [（81.29±1.40）、（91.24±2.02）分] 、 [（79.65±2.80）、（89.47±2.37）分]均较术前 （67.59±1.12）°、（6.76±0.75）分 、（51.88±4.21）分、（53.35±2.89）分显著改善，差异有统计学意义（Ｐ＜0.05）。前抽屉试验、Lachman试验及轴移试验均由术前阳性转为阴性。［结论］ 关节镜下改良双“8”字双隧道治疗Meyers-MckeeverⅡ型胫骨髁间嵴骨折可以达到解剖复位和牢固固定，手术疗效满意。

Abstract:

[Objective] To investigate the clinical effect of modified double "8" double tunnel on Meyers-Mckeever type Ⅱ intercondylar ridge fracture of tibia under arthroscope.[Methods] 17 cases of Meyers-Mckeever type Ⅱ intercondylar ridge fracture of tibia were retrospectively analyzed from October 2015 to May 2020 by modified double "8" double-tunnel under arthroscope, including 13 males and 4 females. The average age was (29.59±8.34) years, ranging from 14 to 49 years. All lesions were unilateral (12 on the right side and 5 on the left side). The knee extension ROM, VAS score, Lyshol score and IKDC score of 17 patients were evaluated before surgery, 3 months after surgery and 1 year after surgery. The anterior drawer test, Lachman test, and axial shift test were examined to assess knee stability. [Results] 17 patients were followed up for 9 to 36 months, the mean follow-up time was (18.53±6.90) months. The average operation time was (45.94±2.93) min. Bone union was achieved within 10-12 weeks after surgery, and the mean healing time of fracture was (11.24±0.75) weeks. The ROM score, VAS score, Lyshol score and IKDC score at 3 months and 1 year after surgery were [(102.18±3.76), (124.06±0.97) °], [(2.29±0.47), (0.94±0.66)], respectively. [(81.29±1.40), (91.24±2.02) points], [(79.65±2.80), (89.47±2.37) points] compared with preoperative (67.59±1.12), (6.76±0.75) points , (51.88±4.21), (53.35±2.89), the difference was statistically significant (P < 0.05). The front drawer test, Lachman test and axial shift test all changed from positive to negative before operation. [Conclusion] The modified double "8" double tunnel under arthroscope for Meyes-McKeever type Ⅱ tibial intercondylar ridge fracture can achieve anatomical reduction and solid fixation, and the operative effect is satisfactory.