关节镜下采用8字缝合法固定治疗前交叉韧带胫骨止点撕脱骨折不愈合

Arthroscopic treatment of nonunited anterior cruciate ligament tibial avulsion fracture with figure-of-8 suture fixation technique.

作者信息

Zhao Jinzhong, Huangfu Xiaoqiao

机构信息

Department of Arthroscopic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, China.

出版信息

Arthroscopy. 2007 Apr;23(4):405-10. doi: 10.1016/j.arthro.2006.12.008.

DOI:10.1016/j.arthro.2006.12.008

PMID:17418334

Abstract

PURPOSE

The purpose of this study was to evaluate the clinical results of arthroscopic treatment of nonunited anterior cruciate ligament (ACL) tibial avulsion fracture with a figure-of-8 suture fixation technique.

METHODS

Nineteen cases of nonunited ACL tibial avulsion fracture were treated with an arthroscopic figure-of-8 suture fixation technique. The patients were followed up and evaluated according to the International Knee Documentation Committee, Lysholm, and Tegner rating scales.

RESULTS

The time interval between the previous injury and this operation was 1 to 8 years, with a mean of 3.6 years. Eighteen patients were followed up for more than 2 years (range, 24 to 30 months; mean, 26 months). The fracture was united within 3 months after surgery in all cases. At the latest follow-up, there was neither extension nor flexion limitation in all patients. With the exception of 1 patient who had a 1 degrees positive Lachman test with a firm end-point, all of the patients had a negative Lachman test. The side-to-side difference in knee anterior laxity was 0 to 2 mm in 17 patients and 4 mm in 1 patient. The Lysholm score was 91 to 100, with a mean of 96.7 +/- 1.9 (compared with 74.3 +/- 4.6 before surgery, P < .05). Fifteen patients returned to their former activity level. The Tegner scores before injury, preoperatively, and at latest follow-up were 6.1 +/- 0.6, 3.6 +/- 1.0, and 6.0 +/- 0.8, respectively; there was no statistically significant difference between the preinjury and postoperative Tegner scores (P > .05). According to the International Knee Documentation Committee scale, 17 patients' knees were graded as normal and 1 patient's knee was nearly normal.

CONCLUSIONS

Arthroscopic treatment of nonunited ACL tibial avulsion fracture with a figure-of-8 suture fixation technique can ensure fracture healing and restore the stability and function of the joint in most patients.

LEVEL OF EVIDENCE

Level IV, therapeutic case series.

摘要

目的

本研究旨在评估采用8字缝合法关节镜治疗前交叉韧带（ACL）胫骨撕脱骨折不愈合的临床效果。

方法

19例ACL胫骨撕脱骨折不愈合患者采用关节镜下8字缝合法固定治疗。根据国际膝关节文献委员会、Lysholm和Tegner评分量表对患者进行随访和评估。

结果

上次受伤至本次手术的时间间隔为1至8年，平均3.6年。18例患者随访超过2年（范围24至30个月，平均26个月）。所有病例骨折均在术后3个月内愈合。在最近一次随访时，所有患者均无伸直或屈曲受限。除1例患者Lachman试验为阳性1度且终点固定外，所有患者Lachman试验均为阴性。17例患者膝关节前向松弛度的左右差值为0至2 mm，1例患者为4 mm。Lysholm评分为91至100分，平均96.7±1.9（术前为74.3±4.6，P <.05）。15例患者恢复至伤前活动水平。受伤前、术前及最近一次随访时的Tegner评分分别为6.1±0.6、3.6±1.0和6.0±0.8；受伤前与术后Tegner评分之间无统计学显著差异（P>.05）。根据国际膝关节文献委员会量表，17例患者的膝关节评分为正常，1例患者的膝关节接近正常。