成人胫骨髁间棘撕脱骨折的手术治疗分析

Operative treatment analysis for adult tibial eminence avulsion fracture

关键词:  成人  胫骨髁间棘骨折  前交叉韧带重建

Key words:  adult  tibial eminence fracture  anterior cruciate ligament reconstruction

摘要:

目的　探讨成人胫骨髁间棘撕脱骨折手术治疗方法的选择和意义。　方法　回顾分析2005年1月—2011年5月手术治疗的31例成人胫骨髁间棘撕脱骨折病例，Meyers—MckeeverⅡ型8例，Ⅲ型10例；ZaricznyiⅣ型13例。根据手术方式的不同，将其分为两组：A组，关节镜下骨折复位内固定术15例；B组，四股腘绳肌腱关节镜下前交叉韧带重建术16例。　结果　全部病例获得随访，随访时间1~6年。术后1年行疗效评定。关节活动度测定：伸膝： 正常 A组 8例，B组 12例；轻度异常 A组 5例，B组 4例；中度异常 A组 2例，B组 0例；重度异常A组 0例，B组 0例。屈膝：正常 A组5例，B组 9例；轻度异常 A组 7例，B组 6例；中度异常 A组 2例，B组 1例；重度异常A组 1例，B组 0例。Lachman试验和前抽屉试验：Ⅰ°A组9例；B组13例；Ⅱ°A组6例；B组3例；Ⅲ°A组0例；B组0例。Lysholm膝关节功能评分：A组90.26±3.72；B组96.32±3.26。两组评分比较，差异有显著性意义（P<0.05）。　结论　成人胫骨髁间棘撕脱骨折多为高能量损伤，损伤类型复杂，要取得好的治疗效果，必须早期进行关节镜探查，准确作出判断，依据骨折撕脱程度、范围、类型以及韧带实质部结构有无损伤，制订出相应的治疗策略。对于骨折撕脱粉碎严重，骨折块小不适宜固定，韧带组织结构有损伤改变的，不能一味强调骨折复位、固定，应有指证地选择前交叉韧带重建的手术方式。可靠的骨折复位、固定有益于关节功能的康复，有指证地选择一期前交叉韧带重建手术，可以更早期地开始关节的康复锻炼，更有助于病人关节功能的恢复，取得好的临床疗效。

Abstract:

[Abstract] Objective To investigate the operative strategy for adult tibial intercondylar eminence avulsion fracture. 　Methods A retrospective analysis was performed in 31 cases of adult tibial intercondylar eminence avulsion fractures between 2005 January and 2011 May. 8 cases of Meyers - Mckeever type II, 10 cases of type Zaricznyi and type IV 13 cases. According to the operative mode, all cases were divided into two groups: group A of arthroscopic reduction and internal fixation of fracture, 15 cases; B group of anterior cruciate ligament reconstruction by four strands of hamstring tendons with arthroscopy, 16 cases. 　Results All cases were followed up, the follow-up time ranges from 1 to 6 years. The curative evaluation was taken one year post operation. Evaluation for the function of joints is as followed: knee extension: 8 normal cases of group A; 12 normal cases of group B; 5 mildly abnormal cases in group A; 4 cases of group A; 2 moderately abnormal cases in group A; 0 cases in group B; 0 severe abnormal case in group A; 0 cases in group B. Knees flexion: 5 normal cases in group A; 9 cases in group B; 7 mildly abnormal cases in group A; 6 cases in group B; 2 moderately abnormal cases in group A; 1 cases in group B; 1 severely abnormal case in group A; 0 case in group B. Lachman test and anterior drawer test: Ⅰ°, 9 cases in group A; 13 cases in group B; Ⅱ°, 6 cases in group A; 3 cases in group B; Ⅲ°, 0 cases in group A; 0 cases in group B. Lysholm knee function scoring system: 90.26±3.72 in group A; 96.32±3.26 in group B. Data were compared between the two groups, the difference was statistically significant (P<0.05). 　Conclusion As a high energy injury, types of adult tibial intercondylar eminence avulsion fracture are complicated. To obtain a good therapeutic effect, evaluation for ligament structure must be early taken by arthroscopy, which is included: avulsion range, damage of ligament structure and so on. For comminuted fracture, small avulsion fracture and ligament tissue structure damage, fracture reduction and fixation is not recommended. Fracture reduction, reliable fixation and rehabilitation is beneficial to the joint function. Anterior cruciate ligament reconstruction operation can be more early to start rehabilitation exercise joints and more conducive to the recovery of joint function of patient.