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摘要 目的 探讨膝关节镜下带线锚钉复合双滑轮技术治疗前交叉韧带(anterior cruciate ligament,ACL)胫骨止点撕脱骨折的临床疗效。方法 回顾性分析2020年1月至2021年9月承德医学院附属秦皇岛市第一医院收治的31例ACL胫骨止点撕脱骨折患者资料,均采用膝关节镜下复合双滑轮技术手术治疗。术后复查膝关节X线、MRI及CT等影像学检查,采用Lysholm膝关节功能评分和国际膝关节文献委员会(international knee documentation committee,IKDC)评分进行主观功能评估,膝关节活动测量仪和KT2000测量仪进行客观评估膝关节功能及稳定性。结果 31例患者术程顺利,术后均获随访,随访时间11~15个月,平均(12.5±1.2)个月;手术时间55~90 min,平均(61.0±5.0) min。术后半年复查骨折均已骨性愈合,无骨折块分离,无膝关节僵硬、感染、深静脉血栓及神经血管损伤等常见并发症。31例患者末次随访时膝关节屈伸活动正常,仅5例患者Lachman试验Ⅰ度弱阳性。Lysholm膝关节运动水平评分、IKDC评分分别由术前的(46.2±7.9)分、(53.8±5.2)分提高到末次随访时(87.2±6.0)分、(83.1±5.3)分;膝关节屈伸活动度由术前的(46.2±7.9) °提高到末次随访的(127.2±5.9) °,屈膝90 ° KT2000测量膝关节胫骨松弛度由术前的(11.5±2.8) mm降低到末次随访时的(2.3±1.2) mm,手术前后比较差异均有统计学意义(P<0.05)。结论 膝关节镜下复合双滑轮技术治疗ACL胫骨止点撕脱骨折安全有效,可获得稳定的骨折固定效果,术后中短期随访临床主客观功能评分和影像学指标满意。
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关键词 :
膝关节镜,
双滑轮,
前交叉韧带,
胫骨止点,
撕脱骨折
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基金资助:秦皇岛市2021年市级科学技术研究与发展(202101A043) |
通讯作者:
刘飞
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作者简介: 李冰(1994- ),男,主治医师,承德医学院附属秦皇岛市第一医院骨科二病区,1146781324@qq.com |
[1]牛金龙,黄远章,王晋豫,等.关节镜下空心螺钉和钢丝治疗前交叉韧带胫骨止点撕脱骨折对比疗效分析[J].实用骨科杂志,2016,22(7):6.
[2]Atsumi S,Arai Y,Nakagawa S,et al.A case of nonunion avulsion fracture of the anterior tibial eminence[J].Case Rep Orthop,2016(2016):9648473.
[3]Defrancesco C J,Wilson L,Lebrun DG,et al.Pediatric tibial spine fractures:Exploring case burden by age and sex[J].Orthop J Sports Med,2021,9(9):941632293.
[4]Chang CJ,Huang TC,Hoshino Y,et al.Functional outcomes and subsequent surgical procedures after arthroscopic suture versus screw fixation for ACL tibial avulsion fractures:A systematic review and meta-analysis[J].Orthop J Sports Med,2022,10(4):951691001.
[5]Meyers MH,Mckeever F.Fracture of the intercondylar eminence of the tibia[J].J Bone Joint Surg Am,1959,41A(2):209-222.
[6]Faivre B,Benea H,Klouche S,et al.An original arthroscopic fixation of adult’s tibial eminence fractures using the Tightrope device:A report of 8 cases and review of literature[J].Knee,2014,21(4):833-839.
[7]Kuang SD,Su C,Zhao X,et al.Figure-of-eight suturebutton technique for fixation of displaced anterior cruciate ligament avulsion fracture[J].Orthop Surg,2020,12(3):802-808.
[8]Niu W J,Huang L A,Zhou X,et al.Clinical effects of arthroscopyassisted anterior cruciate ligament tibial eminence avulsion fracture compared with traditional open surgery:A Metaanalysis[J].Zhongguo Gu Shang,2022,35(3):292-299.
[9]Liu J,Yue Y,Li Z.Arthroscopic treatment of anterior cruciate ligament tibial eminence avulsion fracture with double heads compressive cannulated screw fixation in adolescents[J].Zhongguo Xiufu Chongjian Waike Zazhi,2018,32(9):1172-1176.
[10]Watts CD,Larson AN,Milbrandt TA.Open versus arthroscopic reduction for tibial eminence fracture fixation in children[J].J Pediatr Orthop,2016,36(5):437-439.
[11]Dhillon MS,Virk MS,Kumar P,et al.The effectiveness of arthroscopy assisted fixation of Schatzker types Ⅰ~Ⅲ tibial plateau fractures:Our experience at a tertiary centre[J].Int J Burns Trauma,2021,11(3):163-169.
[12]Mortazavi S,Hasani SS,Vosoughi F,et al.Arthroscopic fixation of anterior cruciate ligament avulsion fracture using fiber wire suture with suture disc[J].Arthrosc Tech,2021,10(7):e1709-e1715.
[13]Tensho K,Shimodaira H,Aoki T,et al.Bony landmarks of the anterior cruciate ligament tibial footprint:A detailed analysis comparing 3-dimensional computed tomography images to visual and histological evaluations[J].Am J Sports Med,2014,42(6):1433-1440.
[14]Guenther D,Irarrázaval S,Albers M,et al.Area of the tibial insertion site of the anterior cruciate ligament as a predictor for graft size[J].Knee Surg Sports Traumatol Arthrosc,2017,25(5):1576-1582.
[15]赵金忠,何耀华,王建华.关节镜下经双后内侧入路治疗急性后十字韧带胫骨止点撕脱骨折[J].中华骨科杂志,2005,25(1):5.
[16]Osti L,Buda M,Soldati F,et al.Arthroscopic treatment of tibial eminence fracture:A systematic review of different fixation methods[J].Br Med Bull,2016,118(1):73-90.
[17]Tang J,Zhao J.Arthroscopic suturetoadjustable loop fixation of adult anterior cruciate ligament tibial avulsion fracture[J].Arthrosc Tech,2021,10(6):e1573-e1579.
[18]Li J,Yu Y,Liu C,et al.Arthroscopic fixation of tibial eminence fractures:A biomechanical comparative study of screw,suture,and suture anchor[J].Arthroscopy,2018,34(5):1608-1616.
[19]Xu X,Liu Z,Wen H,et al.Arthroscopic fixation of pediatric tibial eminence fractures using suture anchors:A midterm follow-up[J].Arch Orthop Trauma Surg,2017,137(10):1409-1416.
[20]Liao W,Li Z,Zhang H,et al.Arthroscopic fixation of tibial eminence fractures:A clinical comparative study of nonabsorbable sutures versus absorbable suture anchors[J].Arthroscopy,2016,32(8):1639-1650.
[21]Hapa O,Barber FA,Süner G,et al.Biomechanical comparison of tibial eminence fracture fixation with high-strength suture,EndoButton,and suture anchor[J].Arthroscopy,2012,28(5):681-687.
[22]Tsukada H,Ishibashi Y,Tsuda E,et al.A biomechanical comparison of repair techniques for anterior cruciate ligament tibial avulsion fracture under cyclic loading[J].Arthroscopy,2005,21(10):1197-1201.
[23]Mahar AT,Duncan D,Oka R,et al.Biomechanical comparison of four different fixation techniques for pediatric tibial eminence avulsion fractures[J].J Pediatr Orthop,2008,28(2):159-162.
[24]Bong MR,Romero A,Kubiak E,et al.Suture versus screw fixation of displaced tibial eminence fractures:A biomechanical comparison[J].Arthroscopy,2005,21(10):1172-1176.
[25]Wolfson T,Vadhera AS,Parvaresh K,et al.Arthroscopic reduction and internal fixation of tibial eminence fractures with transosseous suture bridge fixation[J].Arthrosc Tech,2021,10(4):e1039-e1046.
[26]Defroda SF,Hodax JD,Shah KN,et al.Tibial eminence fracture repair with double hewson suture passer technique[J].Arthrosc Tech,2017,6(4):e1275-e1279.
[27]Zhang Q,Yang J,Zhao G,et al.A new technique for arthroscopic reduction and fixation of displaced tibial intercondylar eminence fractures,using suture anchor and EndoButton system[J].J Orthop Surg(Hong Kong),2017,25(1):612345299.
[28]Chu Y,Hu T,Chen M,et al.Preliminary clinical outcomes of the double-row anchor suture-bridge technique for the fixation of tibial intercondylar eminence fractures in adults:A 12-months minimal follow-up[J].BMC Musculoskelet Disord,2021,22(1):74.
[29]Willinger L,Imhoff AB,Schmitt A,et al.Fixation of bony avulsions of the posterior cruciate ligament by a suture-bridge technique[J].Oper Orthop Traumatol,2019,31(1):3-11.
[30]Jiang L,Chen E,Huang L,et al.Arthroscopy-assisted reduction percutaneous internal fixation versus open reduction internal fixation for tibial plateau fracture:A systematic review and metaanalysis[J].Orthop J Sports Med,2021,9(12):941632894.
[31]Xie L,Chen C,Zhang Y,et al.Three-dimensional printing assisted ORIF versus conventional ORIF for tibial plateau fractures:A systematic review and meta-analysis[J].Int J Surg,2018(57):35-44.
[32]Shimberg JL,Leska TM,Cruz AJ,et al.A multicenter comparison of open versus arthroscopic fixation for pediatric tibial spine fractures[J].J Pediatr Orthop,2022,42(4):195-200.
[33]Verona M,Marongiu G,Cardoni G,et al.Arthroscopically assisted reduction and internal fixation(ARIF) versus open reduction and internal fixation(ORIF) for lateral tibial plateau fractures:A comparative retrospective study[J].J Orthop Surg Res,2019,14(1):155.
[34]Li J,Liu C,Li Z,et al.Arthroscopic fixation for tibial eminence fractures:Comparison of double-row and transosseous anchor knot fixation techniques with suture anchors[J].Med Sci Monit,2018(24):7348-7356.
[35]Wang S,Xiao Y,Tong Z,et al.Effectiveness of arthroscopic treatment of anterior cruciate ligament tibial eminence avulsion fracture with nonabsorbable suture fixation combined with mini-plate[J].Zhongguo Xiufu Chongjian Waike Zazhi,2013,27(9):1041-1044. |
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