CAJ | 학술논문

目的探讨经关节镜下骨折块复位,辅助PDS-Ⅱ丝线内固定治疗儿童胫骨髁间棘撕脱骨折的临床效果.方法选择我院自2009年1月至2010年12月间胫骨髁间棘撕脱骨折的患儿24例(男16例,女8例,年龄8～14岁),采用经关节镜下骨折块复位,以类似成人前交叉韧带重建方式,自胫骨结节内上方1 cm(骨骺上方)以胫骨定位器定位,以直径1～1.2 mm克氏针钻孔,然后以16号腰穿针导入2根不可吸收的PDS-Ⅱ丝线将骨折块及前交叉韧带与胫骨止点进行交叉捆扎固定.术后定期进行随访,根据IKDC、Lyshohn膝关节功能评分进行功能恢复评估.结果本组24例患儿随访6～30个月,术后复查X线显示骨折复位满意,均实现骨性愈合.末次随访,患肢膝关节活动范围恢复满意,无关节僵硬、关节松弛、功能障碍等表现；无骨骺损伤并发症,随访期间未发现患儿出现发育畸形.Lysholm评分由术前(48.6±7.2)分提高到术后(94.5±4.1)分,IKDC2000主观膝关节评分由术前(53.5±4.8)分提高到术后(92.8±3.7)分,差异均有统计学意义(P＜0.001).结论经关节镜下骨折块复位并采用PDS-Ⅱ丝线固定儿童髁间棘撕脱骨折,是一种较好的方法.
목적 탐토경관절경하골절괴복위,보조PDS-Ⅱ사선내고정치료인동경골과간극시탈골절적림상효과.방법 선택아원자2009년1월지2010년12월간경골과간극시탈골절적환인24례(남16례,녀8례,년령8～14세),채용경관절경하골절괴복위,이유사성인전교차인대중건방식,자경골결절내상방1 cm(골후상방)이경골정위기정위,이직경1～1.2 mm극씨침찬공,연후이16호요천침도입2근불가흡수적PDS-Ⅱ사선장골절괴급전교차인대여경골지점진행교차곤찰고정.술후정기진행수방,근거IKDC、Lyshohn슬관절공능평분진행공능회복평고.결과 본조24례환인수방6～30개월,술후복사X선현시골절복위만의,균실현골성유합.말차수방,환지슬관절활동범위회복만의,무관절강경、관절송이、공능장애등표현；무골후손상병발증,수방기간미발현환인출현발육기형.Lysholm평분유술전(48.6±7.2)분제고도술후(94.5±4.1)분,IKDC2000주관슬관절평분유술전(53.5±4.8)분제고도술후(92.8±3.7)분,차이균유통계학의의(P＜0.001).결론 경관절경하골절괴복위병채용PDS-Ⅱ사선고정인동과간극시탈골절,시일충교호적방법.
Objective To explore minimally invasive treatment for tibial intercondylar eminence avulsion fractures under arthroscopy.Methods From Jan 2009 to Dec 2010,24 patient with skeletal immaturity (16 boys and 8 girls,8～ 14 years old) underwent the arthroscopic reduction and PDS-Ⅱ suture fixation of the anterior cruciate ligament or the avulsion fracture.Having taken the advantage of ACL-aimer,the sutures were pulled out and tied outside the joint accurately.According to the standard of International Knee Documentation Committee (IKDC),the Lysholm knee scoring method was used to measure the knee function preoperatively and postoperatively.Results Twenty-four patients were followed up for 6 to 30 months.All patient gained normal range of motion,and the X ray examination demonstrated bone union in all the cases.At the end of the follow-up,all the patients got improved range of movement without complications such as joint stiffness,joint relaxation,epiphyseal injury or malformations dysfunction.The mean Lysholm knee scores were improved from 48.6 ± 7.2 preoperatively to 94.5 ± 4.1 at the end of the follow-up period (P＜0.001)and the mean IKDC subjective evaluation scores were increased from 53.5 ± 4.8 preoperatively to 92.8 ± 3.7 at the end of the follow-up period (P＜0.001).Conclusions The arthroscopical operation with absorbable suture fixation,which leads to less trauma,is a simple and effective alternative for patients with the avulsion fracture of tibial intercondylar eminence.