关节镜下陈旧性胫骨髁间棘骨折治疗.docVIP

关节镜下陈旧性胫骨髁间棘骨折治疗 　【摘要】 探究关节镜辅助下陈旧性胫骨髁间棘骨折的治疗。［方法］15例陈旧性胫骨髁间棘骨折患者，15个膝，分为两组。一组采用关节镜下钢丝固定；一组采用关节镜下胫骨髁间棘骨折清理并重建前交叉韧带。观察骨折愈合情况和膝关节稳定性并行Lysholm膝关节评分评价疗效。［结果］钢丝固定组有6例（Ⅱ型3例，Ⅲ型3例），胫骨髁间棘骨折清理并重建前交叉韧带组有9例（Ⅱ型2例，Ⅲ型5例，Ⅳ型2例），随访时间：10～38个月（平均18个月）。钢丝固定组有1例术后3个月发生固定钢丝断裂，其余5例均于术后6～8周愈合，膝关节稳定性两组无差异。术后6个月Lysholm膝关节功能评分：钢丝固定组为90.9±3.2，胫骨髁间棘骨折清理并重建前交叉韧带组为96.2±3.5，两组比较有统计学差异（Plt;0.05）。［结论］陈旧性胫骨棘骨折多由新鲜骨折治疗不及时或治疗不当演变而来；对于Ⅲ型以上的陈旧性胫骨髁间棘骨折或者受伤后时间较长的陈旧性胫骨髁间棘骨折患者，采用关节镜下胫骨髁间棘骨折清理并一期施行前交叉韧带重建手术，具有治疗时间短、膝关节功能恢复快、临床疗效好等优点。 【关键词】 胫骨髁间棘骨折 陈旧性骨折 关节镜 治疗 Abstract：［Objective］To investigate the treatment of old tibial eminence fractures under arthroscopy.［Method］Fifteen knees in 15 patients with old tibial eminence fractures were divided into two groups.One group were treated with arthroscopic reduction and wires fixation，the other group were treated arthroscopic anterior cruciate ligament reconstruction.We observed the fracture healing with Xray，measured the stability of the knees and evaluated according to Lysholm knee score system.［Result］Six patients in arthroscopic reduction and wires fixation group (three cases of type Ⅱ，three cases of type Ⅲ) and nine patients in arthroscopic anterior cruciate ligament reconstruction group (two cases of type Ⅱ，five cases of type Ⅲ and two cases of type Ⅳ) were followed up for 10 to 38 months (mean，18 months).One case in arthroscopic reduction and wires fixation group was found wire breakage at three months after operation，and the bone healing time in the other five cases were 6～8weeks.There were no differences between two groups in the stability of the knees.The average Lysholm knee score were 90.9±3.2 in arthroscopic reduction and wires fixation group and 96.2±3.5 arthroscopic anterior cruciate ligament reconstruction group at 6 months after operation.There was statistically significance between the two groups（Plt;0.05）in Lysholm knee score.［Conclusion］The old fractures are developed from fresh fractures because of misdiagnosis or malpractice.Arthroscopic anterio