CAJ | 학술논문

目的比较关节镜下螺钉固定与缝线固定治疗前交叉韧带(ACL)胫骨止点撕脱骨折的疗效. 方法回顾性分析2007年11月至2012年11月收治的41例ACL胫骨止点撕脱骨折患者资料,男32例,女9例;年龄8 ～43岁,平均18.3岁.骨折根据Meyers-McKeever-Zaricznyj分型:Ⅱ型12例,Ⅲ型29例.根据固定方式不同分为两组:螺钉固定组19例,男14例,女5例;年龄9 ～42岁,平均18.9岁.缝线固定组22例,男16例,女6例;年龄8～43岁,平均17.8岁.术后记录所有患者的手术时间、膝关节活动度(ROM)、伸膝阻滞例数、Lysholm评分、国际膝关节评分委员会(IKDC)评分、KT-2000检查患侧与健侧位移差值.两组患者年龄、性别、骨折类型、受伤至手术时间等差异均无统计学意义(P＞0.05),具有可比性.结果缝线固定组平均手术时间[(58.9±6.7)min]大于螺钉固定组[(48.5±6.1) min],差异有统计学意义(P＜0.05),螺钉固定组与缝线固定组Lysholm膝关节评分分别为(51.6±6.2)、(95.5±2.6)分,IKDC评分为(91.4±6.4)分、(88.1±7.5)分,患侧与健侧位移差值分别为(2.7±2.6)、(2.8 ±2.7)mm,两组间差异均无统计学意义(P＞0.05).螺钉固定组与缝线固定组分别有3例、2例患者仍出现5°或以上的伸膝阻滞,差异无统计学意义(P＞0.05).结论关节镜下螺钉与缝线固定技术治疗Ⅱ、Ⅲ型前交叉韧带胫骨止点撕脱骨折均能获得良好的稳定性和功能,建议术中透视确认解剖复位,术后早期功能康复锻炼减少关节不稳、活动受限等并发症.
목적 비교관절경하라정고정여봉선고정치료전교차인대(ACL)경골지점시탈골절적료효. 방법 회고성분석2007년11월지2012년11월수치적41례ACL경골지점시탈골절환자자료,남32례,녀9례;년령8 ～43세,평균18.3세.골절근거Meyers-McKeever-Zaricznyj분형:Ⅱ형12례,Ⅲ형29례.근거고정방식불동분위량조:라정고정조19례,남14례,녀5례;년령9 ～42세,평균18.9세.봉선고정조22례,남16례,녀6례;년령8～43세,평균17.8세.술후기록소유환자적수술시간、슬관절활동도(ROM)、신슬조체례수、Lysholm평분、국제슬관절평분위원회(IKDC)평분、KT-2000검사환측여건측위이차치.량조환자년령、성별、골절류형、수상지수술시간등차이균무통계학의의(P＞0.05),구유가비성.결과 봉선고정조평균수술시간[(58.9±6.7)min]대우라정고정조[(48.5±6.1) min],차이유통계학의의(P＜0.05),라정고정조여봉선고정조Lysholm슬관절평분분별위(51.6±6.2)、(95.5±2.6)분,IKDC평분위(91.4±6.4)분、(88.1±7.5)분,환측여건측위이차치분별위(2.7±2.6)、(2.8 ±2.7)mm,량조간차이균무통계학의의(P＞0.05).라정고정조여봉선고정조분별유3례、2례환자잉출현5°혹이상적신슬조체,차이무통계학의의(P＞0.05).결론 관절경하라정여봉선고정기술치료Ⅱ、Ⅲ형전교차인대경골지점시탈골절균능획득량호적은정성화공능,건의술중투시학인해부복위,술후조기공능강복단련감소관절불은、활동수한등병발증.
Objective To compare the curative effects between arthroscopic screw and suture fixations for anterior cruciate ligament (ACL) tibial avulsion fractures.Methods From November 2007 to November 2012,41 patients with ACL tibial avulsion fracture underwent arthroscopy at our department.They were 32 males and 9 females,8 to 43 years of age (average,18.3 years).By the Meyers-McKeever-Zaricznyj classification,12 cases were type Ⅱ and 29 type Ⅲ.There were 19 cases in the screw fixation group,including 14 males and 5 females,9 to 42 years of age (average,18.9 years).The suture fixation group had 22cases,including 16 males and 6 females,8 to 43 years of age (average,17.8 years).Operation time,knee range of motion (ROM),case of flexion contracture,Lysholm score,international knee documentation committee (IKDC) score,and side-to-side mobile difference by KT-2000 were evaluated.The 2 groups were similar in age,gender,fracture type and time from injury to surgery (P ＞ 0.05).Results The operation time for the suture fixation group (58.9 ±6.7 min) was significantly longer than that for the screw fixation group (51.6±6.2 min) (P ＜ 0.05).There were no significant differences between the 2 groups regarding the Lysholm score (96.2 ± 2.83 for the screw fixation group versus 95.5 ± 2.6 for the suture fixation group),the IKDC score (91.4 ± 6.4 for the screw fixation group versus 88.1 ± 7.5 for the suture fixation group),the side-to-side mobile difference by KT-2000 (2.7 ± 2.6 mm for the screw fixation group versus 2.8 ± 2.7 mm for the suture fixation group (P ＜ 0.05).Flexion contracture of ≥ 5° occurred in 3 cases in the screw fixation group and 2 cases in the suture fixation group,showing no significant difference (P ＞ 0.05).Conclusions In treatment of ACL tibial avulsion fractures of types Ⅱ and Ⅲ,there is no significant difference between arthroscopic screw fixation and suture fixation,because both methods can achieve good stability and functional recovery.Intraoperative fluoroscopy should be used to ensure anatomical reduction and early functional rehabilitation should be encouraged postoperatively to reduce such complications as joint instability and limited motion.