摘要
目的探讨关节镜下辅助复位,2.0 mm带孔克氏针建立骨隧道,不可吸收缝线"8"字缝合固定儿童胫骨髁间嵴骨折的临床疗效。方法回顾性分析2018年1月至2020年12月南京医科大学附属儿童医院收治的胫骨髁间嵴骨折患儿24例的临床资料。24例中,男14例,女10例;年龄6~15岁。患儿均采用关节镜下骨折复位,高强度不可吸收缝线前交叉韧带基底部"8"字缝合,经胫骨近端骨骺2.0 mm带孔克氏针钻孔建立骨隧道并过线,关节外打结固定骨折块,术后石膏固定4周,4周后拆除石膏主动功能锻炼。术后采用Lysholm评分和IKDC2000主观评分评估膝关节功能恢复情况,Lachman试验评估膝关节稳定性,术后3、6个月复查X线片评估骨折愈合情况,术后2年摄双膝X线片评估是否存在骨骺早闭情况。结果24例患儿均顺利完成手术,手术时间40~115 min[(63.1±20.2)min]。患儿均随访,随访时间24~36个月[(28.7±3.4)个月]。术后X线片解剖复位,未见骨折再移位、缝线断裂及感染等并发症,术后3个月均骨性愈合。末次随访时膝关节功能评分Lysholm评分(94.4±4.8)分;IKDC2000主观评分(93.8±5.6)分,2例患儿Lachman试验阳性,均未发现胫骨近端骨骺生长受抑制。结论采用关节镜辅助复位,2.0 mm带孔克氏针建立胫骨隧道,不可吸收缝线"8"字缝合治疗儿童胫骨髁间嵴骨折,具有关节内操作简单、手术创伤小等优点,是一种有效的手术方式。
Objective To investigate the clinical effect of arthroscopic reduction of tibial intercondylar ridge fractures in children using a 2.0 mm perforated Kirschner wire to establish bone tunnels and the Krackow-"8"suture.Methods From January 2018 to December 2020,24 children(14 males and 10 females,aged 6-15 years)with tibial intercondylar ridge fractures admitted to Children′s Hospital of Nanjing Medical University were retrospectively recruited for analyses.All patients were treated with arthroscopic reduction,non-absorbable Krackow-"8"suture for the base of the anterior cruciate ligament,and establishment of bone tunnels by 2.0 mm perforated Kirschner wire from the proximal tibial epiphysis for inserting a suture to fix the fractures.The affected limb was immobilized with a cast for 4 weeks,followed by active exercises postoperatively.Knee function was assessed using the Lysholm score and IKDC 2000 subjective score.Knee stability was evaluated using the Lachman test.X-rays were taken at 3 and 6 months postoperatively to evaluate fracture healing.Growth retardation of epiphyseal plate at 2 years of follow-up was assessed by bilateral knee X-rays.Results All the 24 cases were successfully operated,with the operation time of(63.1±20.2)(40-115)min.All children were followed up for 24-36 months[(28.7±3.4)months].All children achieved an anatomical reduction of the fracture postoperatively.No complications like fracture displacement,suture rupture,or infection were reported.All fractures healed completely at 3 months postoperatively.At the last follow-up,the Lysholm score and IKDC 2000 subjective score were(94.4±4.8)points and(93.8±5.6)points,respectively.The positive Lachman test was detected in 2 patients.No inhibition of proximal tibial epiphyseal growth was observed.Conclusions Arthroscopic reduction with non-absorbable Krackow-"8"suture and establishment of bone tunnels using a 2.0 mm perforated Kirschner wire for the treatment of tibial intercondylar ridge fractures in children has the advantages of simple surgical procedures,minimal invasiveness,which is an effective treatment method.
作者
刘飞
侯华成
鞠黎
冒锋涌
唐凯
Liu Fei;Hou Huacheng;Ju Li;Mao Fengyong;Tang Kai(Department of Orthopedics,Children's Hospital of Nanjing Medical University,Nanjing 210008,China)
出处
《中华实用儿科临床杂志》
CAS
CSCD
北大核心
2023年第9期693-697,共5页
Chinese Journal of Applied Clinical Pediatrics
关键词
胫骨
骨折
内固定
关节镜
克氏针
Tibia
Fracture
Internal fixation
Arthroscopy
Kirschner wire
