關節鏡下規避骺板“8”字法縫線固定治療急性兒童前交叉韌帶脛骨止點撕脫性骨折

[摘要] 目的 選取該院探討關節鏡下實施規避骺板“8”字法縫線固定術治療急性兒童前交叉韌帶脛骨止點撕脫性骨折的臨床療效。方法 2011年3月— 2015年3月收治的關節鏡下膝關節前內、外側及輔助正中入路，采用“8”字法縫線固定治療急性兒童膝關節前交叉韌帶脛骨止點撕脫性骨折的22例患者進行回顧性分析， 術后隨訪2年（14～32個月，平均26個月），對其進行臨床評價，包括前抽屜試驗、Lachman試驗評價膝關節穩定性，根據Lysholm評分、IKDC評分及Tegner評分來術后評價膝關節功能，術后骨折部位X線及CT評價骨折復位愈合情況。 結果 術后3個月 X 線及CT片示骨折均為解剖復位或近解剖復位，均達到骨性愈合。患者前抽屜試驗Lachman試驗及均為陰性，術后膝關節Lysholm評分（86～96分）（94.7±3.3）分、IKDC評分為（72.2～94.1分）（84.6±3.2）分，Tegner評分7～9分（8.35±1.4）分，較術前差異有統計學意義（P < 0.01）。體檢步態均正常，測量雙小腿長度差異無統計學意義。 結論 關節鏡下規避骺板“8”字法縫線固定術治療急性兒童前交叉韌帶脛骨止點撕脫性骨折療效確切、創傷小、固定可靠、膝關節活動度及功能好，不影響兒童生長發育。

[關鍵詞] 兒童；前交叉韌帶；撕脫骨折；縫線；關節鏡；骨折固定術；脛骨

[中圖分類號] R5 [文獻標識碼] A [文章編號] 1674-0742（2016）10（b）-0047-04

[Abstract] Objective To study the treatment efficiency and function recovery of acute anterior cruciate ligament tibial avulsion fractures under arthroscopic with figure-of-eight suture fixation without epiphyseal interference in children. Methods From March 2011 to March 2015 ，a retrospective analysis was conducted on 22 children patients with anterior cruciate ligament tibial avulsion fracture who were treated arthroscopic used anterolateral、anteromedial、and median portals with figure-of-eight suture fixation without epiphyseal interference.The average follow-up for more than two years（range 14 to 32 months，mean 26 months）.The follow-up assessment included anterior drawer test、Lachman test、Lysholm、IKDC knees core and the radiological evaluation. Results Fractures were united within 3 months after opemtion in all cases.The knee function was good.The results of anterior drawer test、Lachman test were negative.Postoperatively，the Lysholm knee score was （94.7±3.3）points（86～96）points，the IKDC knee score was （84.6±3.2）points（72.2～94.1）points，the Tegner knee score was 7～9（8.35±1.4）points. The difference was statistically significant （P < 0.01）. There was no significant difference in the length of the double leg between the physical examination and the normal gait. Conclusion The arthroscopic figure-of-eight fixation for acute anterior cruciate ligament tibial avulsion fractures in children using suture sisminimally invasive 、 convenient with satisfactory reduction and fixation、without affect children's growth and development、which can benefit the posoperative rehabilitation.

[Key words] Children；Anterior cruciate ligament；Avulsion fractures；Sutures；Arthroscopic；Fracture fixation；Tibial

隨著運動傷、交通傷的不斷增多，兒童ACL脛骨止點骨折在兒童膝關節損傷中較為常見，8～13歲為高發期[1]。由于兒童ACL脛骨止點骨折位于膝關節內，骨折后若治療不當可引起骨折部位不愈合及ACL松弛，嚴重時可出現膝關節不穩定，甚至一起膝關節內主要結構的損傷，導致膝關節功能障礙，給患者工作和生活帶來極大的困擾[2]。……