陈建军 梁剑伟 胡光亮 叶湛

[摘要] 目的 探討关节镜下非经骨隧道缝线固定治疗儿童胫骨髁间嵴撕脱骨折的临床疗效。 方法 回顾分析2015年1月～2018年12月我科收治的儿童胫骨髁间嵴撕脱骨折病例14例，根据Meyers-McKeever分型：Ⅱ型8例，Ⅲ型6例。采用关节镜下，两根5#爱惜邦不可吸收缝合线从撕脱骨折块前交叉韧带止点基底部处后方穿过并在前方交叉，腰穿针引导在内外侧半月板前角下方穿出，复位骨折块，收紧缝线，在胫骨结节内下方予锚钉固定。 结果 平均随访时间16个月，术前术后采用Lyshlom评分法进行功能评价，术前Lyshlom评分平均41.6（41.6±2.1）分，术后1年Lyshlom评分平均95.8（95.8±1.6）分，差异有统计学意义（P<0.05）。末次随访X线片显示骨折处均骨性愈合。膝关节屈伸活动功能良好。 结论 关节镜下非经骨隧道缝线固定治疗儿童胫骨髁间嵴撕脱骨折手术创伤小、术后恢复快，避免了损伤骨骺的风险，且无需再次手术取出内固定物，临床疗效满意。

[关键词] 胫骨髁间嵴骨折;儿童;关节镜;缝线;骨折固定术

[中图分类号] R683.42          [文献标识码] B          [文章编号] 1673-9701（2020）17-0076-04

Arthroscopic non-transosseous suture fixation for tibial intercondylar avulsion fractures in children

CHEN Jianjun   LIANG Jianwei   HU Guangliang   YE Zhan

Department of Orthopaedics， the First People's Hospital of Taizhou City in Zhejiang Province， Taizhou   318020， China

[Abstract] Objective To explore the clinical effect of arthroscopic non-transosseous suture fixation for tibial intercondylar avulsion fractures in children. Methods A total of 14 cases of tibial intercondylar avulsion fractures children treated in our department from January 2015 to December 2018 were retrospectively analyzed. According to the Meyers-McKeever classification： 8 cases were type Ⅱ and 6 cases were type Ⅲ. Two 5# non-absorbable sutures were passed from the base of the anterior cruciate ligament stop of the avulsion fracture block and crossed in front under arthroscopy. The lumbar puncture was guided below the anterior angle of the inner and outer meniscus. The fracture block was reduced， the suture was tightened， and the anchor was fixed under the tibial tubercle. Results The average follow-up time was 16 months. Lyshlom score was used for functional evaluation before and after surgery. The average Lyshlom score was 41.6 （41.6±2.1） points before surgery， which was lower than 95.8 （95.8±1.6） points at 1 year after surgery， and the difference was statistically significant（P<0.05）. The final follow-up X-ray showed all fracture sites were healed. The knee flexion and extension function was good. Conclusion Arthroscopic non-transosseous tunnel suture fixation in children with tibial intercondylar avulsion fractures has less trauma and rapid postoperative recovery， avoids the risk of osteophyseal injury， and does not require surgery to remove internal fixation. Its clinical effect is satisfactory.

[Key words] Tibial intercondylar fracture; Children; Arthroscopy; Suture; Fracture fixation

胫骨髁间嵴骨折是发生在膝关节前交叉韧带胫骨止点处的骨折，易发生撕脱移位，在骨科临床较为少见。好发于8～14岁的儿童人群， 发病率约为3/100 000[1]。胫骨髁间嵴撕脱移位骨折如漏诊或未及时采取恰当的治疗，可因骨折的不愈合、畸形愈合导致前交叉韧带松弛而出现膝关节不稳、活动障碍等严重并发症[2，3]。因此，移位的胫骨髁间嵴撕脱骨折多主张进行手术治疗，对骨折块进行复位并固定。随着关节镜手术的广泛开展，关节镜下治疗胫骨髁间嵴撕脱骨折已成为主要手术方式，但对骨折固定的方式较多，儿童因胫骨近端的骨骺多未闭合，在对骨折进行复位固定的同时避免或尽可能减少对骨骺的损伤仍是治疗研究的关注重点。……