关节镜下胫骨髁间隆突撕脱骨折治疗.docVIP

关节镜下胫骨髁间隆突撕脱骨折治疗【中图分类号】R687.3 【文献标识码】A 【文章编号】1672－3783(2012)01－0001－01 【摘要】 目的：探讨关节镜下微创技术治疗胫骨髁间隆突撕脱骨折的几种手术方法，并观察其疗效。? 方法：2006年1月至2011年5月，对我科收治的胫骨髁间隆突撕脱骨折的患者，进行关节镜下微创治疗，共30例，其中男18例，女12例。新鲜损伤26例，陈旧损伤4例；伴内侧半月板前角一起撕裂者4例；伴半月板其它部位损伤6例。10例髁间隆突撕脱骨折，应用带线锚钉交叉缝合复位，骨皮质外打结固定。12例采用多骨道、交叉缝线/钢丝缝合复位、骨皮质外打结固定。8例采用空心拉力螺钉固定。术中同时处理半月板损伤。术后即可进行10°―90°范围内的伸屈练习以防粘连。其它同交叉韧带重建渐进式训练。? 结果：全部患者均得到随访，平均随访14.5（3―31）个月，术后三个月有六例屈曲受限，活动范围0°―90°，至术后6个月，屈曲度达110°―130°，其余患者均恢复正常膝关节活动范围。X光片示骨折骨性愈合，个别病例粉碎性小骨片翘起但对功能无影响。伴有半月板前撕裂一起缝合的患者，恢复良好，复查无半月板损伤的症状、体征。2例lachman试验轻度阳性。按lysholm功能评分术后6―8个月平均为91.6。? 结论：对于胫骨髁间隆突撕脱骨折患者进行关节镜下治疗，创伤小，固定牢固，功能效果良好。术中应根据撕脱骨块的大小，选择不同的固定方法及材料。对于连带半月板前角撕裂的病例，一同缝合固定，可避免半月板的切除。? 【关键词】 胫骨髁间隆突撕脱骨折 治疗 关节镜技术 手术方法 ? A Study Of Arthroscopic Treatment for The Tibia Intercondylar Eminence Fracture? 【Abstract】 Objective: To explore some techniques of reduction and internal fixation for tibia intercondylar eminence fractures under arthroscopy,and evaluate the efficacy of these surgery treatments.Methods: Between January 2006 and May 2011，30 patients（18 men and 12 women） with tibia intercondylar eminence fractures were treated with arthroscopic reduction and fixation using arthroscopic screw、nonabsorbable sutures / Steel wires and suture anchors,of which 2 cases were obsolete fractures and other 28 cases were fresh fractures.Besides,4 cases were associated with the anterior horn of meniscus injury,and 6 cases were with other parts of the meniscus injury. 12 patients with tibia intercondylar eminence fracture were treated with arthroscopic reduction and fixation using nonabsorbable sutures/stainless steel wire,10 patients ueing suture anchors and 8 patients using arthroscopic screw.We also treated the meniscus injury during the surgery.After the surgery we give a exercise of 10°―90°ROM for each patient to prevent the joint adhesion.The other function exercise for these patients was jast the same as the progressive training of the reconstruction of anterior cruciate ligament.Res