镜下双领带结缝线桥固定胫骨髁间嵴Meryers IV型骨折

Arthroscopic double- tie-knot suture bridge for fixation of Meryers type IV tibial intercondylar eminence fractures

摘要:

[目的] 介绍关节镜下双领带结缝线桥固定 Meryers IV 型前交叉韧带胫骨髁间嵴撕脱骨折的手术技术与初步效果。 [方法] 2019 年 10 月—2021 年 9 月对 9 例 Meyers-McKeever Ⅳ型胫骨髁间嵴撕脱骨折行镜下双领带结缝线桥固定。镜下清创复位后，用 Lasso 缝合钩，环绕前交叉韧带根部，行 2 个环形缝线套扎固定，将两股缝线尾端拉出关节外，分别将不同领带结的尾线合为一束，形成网状缝线桥。分别于骨折区前内缘和前外缘建立 2 个至胫骨前内侧面的骨道。将两侧缝线束分别引入骨道，至胫骨近端前内侧面拉出、收紧打结固定。[结果] 9 例患者均顺利完成手术，术后切口均Ⅰ期愈合，无感染、皮肤坏死及神经血管损伤等并发症发生。随访 11~26 个月，末次随访患者膝关节均恢复稳定，Lachman 试验和前抽屉试验均为阴性，无跛行、绞锁等表现，膝关节伸屈活动度可达 0°~130°；生活和运动均恢复伤前水平。与术前相比，末次随访时膝关节 IKDC 评分显著改善 [(43.9±3.6), (90.3±2.9), P＜0.001]，Lysholm 评分显著改善 [(32.6±2.2), (92.7±2.5), P＜0.001]。术后影像显示所有患者均达到良好骨折复位，骨折均于术后 8~15 周愈合。[结论]关节镜下撬拨复位，双领带结缝线桥固定 Meryers IV 型胫骨髁间嵴粉碎性撕脱骨折，技术简单有效，初步临床效果满意。

Abstract:

[Objective] To introduce the surgical technique and preliminary results of arthroscopic double-tie-knot suture bridge for fixation of Meryers type IV tibial intercondylar eminence fractures. [Methods] From October 2019 to September 2021, 9 patients received abovementioned surgical procedures for Meyers-McKeever type Ⅳ tibial intercondylar eminence fractures. After arthroscopic debridement and fracture reduction, the lasso suture hook was used to placed two loop sutures around the root of anterior cruciate ligament, and the one end of each suture bundle was crossed over the anterior surface of the ligament to form a suture bridge, then pulled out of the joint. Two bone tunnels 2 mm in diameter were established from the anteromedial and anterolateral margins of the fracture area to the anteromedial surface of the proximal tibia respectively under a ACL guide. Both sides of the suture bundle were introduced into the bone tunnels accord- ingly, pulled out to the anterior medial side of the proximal tibia, finally were tightened and tied for fixation. [Results] All the 9 patients were successfully operated on, with good incisions healing, whereas without complications, such as infection, skin necrosis and neurovascu- lar injury. At the latest follow-up lasted from11 to 26 months, all patients had the stable affected knee with negative Lachman test and ante- rior drawer test, with no claudication or locking, and achieved knee extension-flexion range of motion 0 to 130°, restored to the pre-injury level of daily activity. Compared with those preoperatively, the IKDC score [(43.9±3.6), (90.3±2.9), P＜0.001] and Lysholm score [(32.6± 2.2), (92.7±2.5), P＜0.001] significantly improved at the latest follow-up. In addition, the postoperative images showed good fracture reduc- tion in all patients with fracture healing within 8 to 15 weeks after surgery. [Conclusion] The arthroscopic double-tie-knot suture bridge for fixation of Meryers type IV tibial intercondylar eminence fractures is a simple and effective technique, and achieves satisfactory prelimi- nary clinical consequence.