关节镜下空心钉固定和缝线固定治疗胫骨髁间棘撕脱骨折疗效评价

摘要

目的:探究关节镜下空心钉固定和缝线固定在治疗胫骨髁间棘撕脱骨折上的疗效对比.方法:对2015年1月~2016年3月之间我院收治的100例胫骨髁间棘撕脱骨折患者,根据手术方案分为空心钉组和缝线组各50例,两组患者均在关节镜下完成治疗,空心钉组患者采用空心钉内固定治疗,缝线组则采用缝线固定,对比两组患者的手术时间、愈合情况、膝关节活动度、Lysholm评分和IKDC评分.结果:空心钉组患者的手术时间为(62.4±6.7)min,低于缝线组患者的(75.9±9.6)min,差异具有统计学意义(t=-7.949,P<0.05);两组患者术后随访6个月,均能在术后3个月内获得骨性愈合,末次随访两组患者的膝关节活动度均恢复正常,前抽屉试验及Lachman试验无阳性病例;两组患者的Lysholm评分和IKDC评分对比差异无统计学意义(P>0.05).两组均未见固定不良、骨不愈等相关不良反应.结论:关节镜下空心钉固定和缝线固定治疗胫骨髁间棘撕脱骨折均能获得较好疗效,空心钉固定治疗手术时间较短,但需行二次手术,建议临床根据需求选择具体手术方案.%Objective:To assess the therapeutic effects of arthroscopic cannulated screw fixation and suture fixation in the treatment of tibial intercondylar avulsion fractures.Methods:One hundred patients with tibial intercondylar avulsion fractures treated in our hospital between January 2015 and March 2016 were included and allocated to two groups by the surgical modality ( n=50 for each group) .Patients in one group received cannulated screw fixation and another group were treated with suture fixation under arthroscopy.Then the two groups were compared regarding the operative time,fracture healing,knee motion,Lysholm and IKDC scores.Results:The operative time was (62.4±6.7) min for patients treated with cannulated screw fixation and (75.9±9.6) min for those treated with suture fixation.The difference was significant (t=-7.949,P<0.05).Patients in the two groups were followed for 6 months.Bony union occurred in general in three months after surgery.Final follow-up indicated that patients in the two groups were recovered to normal knee joint activi-ty.There were no positive cases by anterior drawer stress test and Lachman test,and no significant differences between groups by Lysholm and IKDC sco-ring (P>0.05).No incidences,including poor fixation or refusal of the healing of the bones,occurred in two groups.Conclusion:Arthroscopic cannulated screw fixation and suture fixation may lead to better curative effects for tibial intercondylar avulsion fractures .Although cannulated screw fixation can be shorter operative time,yet it requires second operation.Therefore,surgical modality for this fracture should be planned on the patient′s condition basis.