[1]胡勇,程松苗,唐杰.应用改良的关节镜下带垫片的空心螺钉内固定技术治疗儿童[J].陆军军医大学学报(原第三军医大学学报),2008,30(15):1424-1426.
 HU Yong,CHENG Song-miao,TANG Jie.Modified arthroscopic internal fixation of avulsion fracture of the anterior cruciate ligament from the tibial insertion site with cannulated screw and washer[J].J Amry Med Univ (J Third Mil Med Univ),2008,30(15):1424-1426.
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陆军军医大学学报(原第三军医大学学报)[ISSN:1000-5404/CN:51-1095/R]

卷:
30卷
期数:
2008年第15期
页码:
1424-1426
栏目:
论著
出版日期:
2008-08-15

文章信息/Info

Title:
Modified arthroscopic internal fixation of avulsion fracture of the anterior cruciate ligament from the tibial insertion site with cannulated screw and washer
作者:
胡勇程松苗唐杰
四川省骨科医院运动创伤科;解放军第452医院骨科
Author(s):
HU Yong CHENG Song-miao TANG Jie
Department of Sports Injury, Sichuan Province Orthopedics Hospital, Department of Orthopedics, No. 452 Hospital of PLA, Chengdu 610041, China
关键词:
前交叉韧带撕脱骨折开放骺板关节镜
Keywords:
anterior cruciate ligament avulsion fracture open physis arthroscopy
分类号:
R683.42; R684; R687.32
文献标志码:
A
摘要:
目的  探讨应用改良的关节镜下带垫片的空心螺钉内固定技术治疗儿童膝关节前交叉韧带(anterior cruciate ligament, ACL)胫骨止点撕脱性骨折的术后5年疗效。 方法  2000年3月至2003年11月,应用改良关节镜下带垫片的空心螺钉内固定技术治疗骨骺未闭合的儿童ACL胫骨止点撕脱性骨折39例。全部患者术后定期摄正侧位X线平片以判定骨折愈合情况。术后随访5年以上的患者采用膝关节Lysholm和Tegner评分以评价术前、术后伤膝功能,临床查体结合正侧位摄片检查有无肢体短缩或成角畸形,并行KT-2000测试以检测伤膝关节稳定性。 结果  经X线摄片证实骨折满意愈合后,39例患者于术后3~6个月返院行关节镜手术摘除了内植物,其中31例获得了5年以上随访。该组患者未发现伤肢肢体短缩或成角畸形,亦无伤膝不稳的主诉。术前Lysholm评分为12~48(19.2±14.8)分,术后5年的Lysholm评分为97~100(98.5±3.1)分(t=18.40, P<0.01),术前Tegner评分为3~5(4.1±1.1)分,术后5年Tegner评分为7~9(8.5±0.8)分(t=4.13, P<0.01)。14名患者的KT-2000测试(手动模式)提示患/健侧胫骨前向位移之差大于2 mm(2.1~3.8 mm),其临床查体亦证实Lachman试验阳性。 结论  关节镜下应用带垫片的空心螺钉治疗骨骺未闭合儿童ACL胫骨止点撕脱性骨折的改良技术是简便、安全、可靠的ARIF手术方法,不会影响伤肢的生长发育。
Abstract:
Objective    To evaluate more than 5-year follow-up outcome of avulsion fracture of the anterior cruciate ligament from the tibial insertion site in skeletally immature patients treated with modified arthroscopic internal fixation with cannulated screw and washer.      Methods    Thirty-nine patients with open physis were treated by modified arthroscopic internal fixation with cannulated screw and washer from March 2000 to November 2003. Regular X-ray plain films at AP and lateral views were conducted to detect the healing of avulsed fragments. Follow-up period of 31 patients was more than 5 years. Functional outcome before and after surgery was evaluated using the Lysholm Knee Score and the Tegner Activity Score. Angular deformity, or leg length discrepancy was assessed by clinical examination and anteroposterior-lateral radiographs of the knee. Instrumented knee laxity was performed using the KT-2000 arthrometer.      Results    Arthroscopic removal of implants was performed between 3 and 6 months postoperatively, when all fractures were revealed to have healed on X-ray films. No growth disturbance, angular deformation or knee instability was found in 31 patients during more than 5-year follow-up. The Lysholm score was improved from (19.2±14.8) (range 12-48) preoperatively to (98.5±3.1) (range 97-100) postoperatively, with significant statistical difference by the student-t test (t=18.395, P=0.000); The Tegner score was improved from (4.1±1.1) (range 3-5) preoperatively to (8.5±0.8) (range 7-9) postoperatively, with significant statistical difference by the student-t test (t=4.13, P=0.008). Physical examination showed Lachman test (+) in 14 of 31 patients. Instrumented knee laxity (KT-2000) showed manual-maximum side-to-side difference greater than 2 mm (range 2.1-3.8 mm)  in 14 of 31 patients.      Conclusion    Modified arthroscopic internal fixation of avulsion fracture of the anterior cruciate ligament from the tibial insertion site with cannulated screw and washer in skeletally immature patients is a simple, safe, and effective ARIF procedure without growth disturbance.

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更新日期/Last Update: 2008-07-24