[1]刘玉强,郭旗,梁振雷,等.关节镜下胫骨隧道法与骺板规避法缝线固定治疗儿童前交叉韧带胫骨止点撕脱骨折的比较研究[J].中医正骨,2017,29(06):12-15,24.
　LIU Yuqiang,GUO Qi,LIANG Zhenlei,et al.A comparative study of tibial tunneling method versus epiphyseal plate evading method in arthroscopic fixation with suture for treatment of anterior cruciate ligament tibial insertion avulsion fractures in children[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2017,29(06):12-15,24.
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关节镜下胫骨隧道法与骺板规避法缝线固定治疗儿童前交叉韧带胫骨止点撕脱骨折的比较研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第29卷
期数:
2017年06期
页码:
12-15,24
栏目:
临床研究
出版日期:
2017-06-20

文章信息/Info

Title:
A comparative study of tibial tunneling method versus epiphyseal plate evading method in arthroscopic fixation with suture for treatment of anterior cruciate ligament tibial insertion avulsion fractures in children
作者:
刘玉强; 郭旗; 梁振雷; 王续鹏; 胡滨; 刘宁
河南省郑州市骨科医院,河南 郑州 450052
Author(s):
LIU Yuqiang; GUO Qi; LIANG Zhenlei; WANG Xupeng; HU Bin; LIU Ning
Zhengzhou Orthopaedic Hospital,Zhengzhou 450052,Henan,China
关键词:
前交叉韧带;  胫骨;  撕脱骨折;  骨骺;  关节镜检查;  缝线;  儿童
Keywords:
Key words anterior cruciate ligament;  tibia;  avulsion fracture;  epiphyses;  arthroscopy;  sutures;  child
摘要:
目的:比较关节镜下胫骨隧道法与骺板规避法缝线固定治疗儿童前交叉韧带胫骨止点撕脱骨折的临床疗效和安全性。方法:回顾性分析27例儿童前交叉韧带胫骨止点撕脱骨折患者的病例资料,其中采用关节镜下胫骨隧道法缝线固定15例,采用关节镜下骺板规避法缝线固定12例。男20例,女7例; 年龄5～14岁,中位数10岁; 按Meyers-Mckeever胫骨止点撕脱骨折分型,Ⅱ型17例、Ⅲ型10例; 受伤至手术时间5～34 d,中位数14 d。分别比较术前和末次随访时2组患者的膝关节活动度、Lysholm膝关节评分和国际膝关节文献委员会(the international knee documentation committee,IKDC)膝关节评分,并比较2组患者胫骨骺板损伤发生情况。结果:术前2组患者膝关节活动度、Lysholm膝关节评分、IKDC膝关节评分比较,组间差异均无统计学意义[38.67°±6.20°,39.92°±7.42°,t=0.480,P=0.640;(40.87±6.32)分,(41.75±6.25)分,t=0.360,P=0.720;(50.01±5.71)分,(47.42±4.91)分,t=1.240,P=0.230]。末次随访时,2组患者膝关节活动度、Lysholm膝关节评分、IKDC膝关节评分比较,组间差异均无统计学意义[131.07°±8.60°,131.33°±9.21°,t=0.080,P=0.940;(92.73±4.43)分,(92.81±4.01)分,t=0.110,P=0.910;(93.27±3.92)分,(93.92±3.18)分,t=0.470,P=0.650]; 2组患者膝关节活动度、Lysholm膝关节评分、IKDC膝关节评分均高于术前(t=31.250,P=0.000,t=31.070,P=0.000; t=25.720,P=0.000,t=25.740,P=0.000; t=22.940,P=0.000,t=22.890,P=0.000)。胫骨隧道法固定组4例术后出现胫骨近端持续轻度疼痛,1例术后13个月在骺板内有骨桥形成; 骺板规避法固定组无胫骨骺板损伤表现; 骺板规避法固定组胫骨骺板损伤发生率低于胫骨隧道法固定组(P=0.047)。结论:对于儿童前交叉韧带胫骨止点撕脱骨折患者而言,关节镜下胫骨隧道法与骺板规避法缝线固定在改善膝关节活动度、恢复膝关节功能方面无明显差异,但骺板规避法固定较胫骨隧道法固定能更好地降低胫骨骺板损伤的风险。
Abstract:
ABSTRACT Objective:To compare the clinical curative effect and safety of tibial tunneling method versus epiphyseal plate evading method in arthroscopic fixation with suture for treatment of anterior cruciate ligament(ACL)tibial insertion avulsion fractures in children.Methods:The medical records of 27 children with ACL tibial insertion avulsion fractures were analyzed retrospectively.Fifteen children were treated with arthroscopic fixation with suture by using tibial tunneling method(group A),while the others were treated with arthroscopic fixation with suture by using epiphyseal plate evading method(group B).The children consisted of 20 boys and 7 girls,aged 5-14 years(Median=10 yrs)and ranged in disease course from 5 to 34 days(Median=14 days).The fractures belonged to Meyers-Mckeever typesⅡ(17)andⅢ(10).The range of motion(ROM)of knee,Lysholm knee scores and the international knee documentation committee(IKDC)scores were recorded and compared between the 2 groups before treatment and at the last follow-up respectively.The incidence rate of tibial epiphyseal plate injuries were also compared between the 2 groups.Results:There was no statistical difference in knee ROM,Lysholm knee scores and IKDC knee scores between the 2 groups before the surgery and at the last follow-up(38.67+/-6.20 vs 39.92+/-7.42 degrees,t=0.480,P=0.640; 40.87+/-6.32 vs 41.75+/-6.25 points,t=0.360,P=0.720; 50.01+/-5.71 vs 47.42+/-4.91 points,t=1.240,P=0.230; 131.07+/-8.60 vs 131.33+/-9.21 degrees,t=0.080,P=0.940; 92.73+/-4.43 vs 92.81+/-4.01 points,t=0.110,P=0.910; 93.27+/-3.92 vs 93.92+/-3.18 points,t=0.470,P=0.650).Knee ROM,Lysholm knee scores and IKDC knee scores were higher at the last follow-up compared to pre-surgery in the 2 groups(t=31.250,P=0.000,t=31.070,P=0.000; t=25.720,P=0.000,t=25.740,P=0.000; t=22.940,P=0.000,t=22.890,P=0.000).The sustained mild pain in proximal tibia(4 cases)was found after the surgery and bone bridge(1 case)was found in the epiphyseal plate at 13 months after the surgery in group A.No tibial epiphyseal plate injuries were found in group B.The incidence rate of tibial epiphyseal plate injuries was lower in group B compared to group A(P=0.047).Conclusion:There is no significant difference in improvement of knee ROM and recovery of knee function between tibial tunneling method and epiphyseal plate evading method in arthroscopic fixation with suture for treatment of ACL tibial insertion avulsion fractures in children.However,the latter surpasses the former in decreasing risks of tibial epiphyseal plate injuries.

参考文献/References:

[1] LAFRANCE RM,GIORDANO B,GOLDBLATT J,et al.Pediatric tibial eminence fractures:evaluation and management[J].J Am Acad Orthop Surg,2010,18(7):395-405.
[2] LIAO W,LI Z,ZHANG H,et al.Arthroscopic fixation of tibial eminence fractures:a clinical comparative study of nonabsorbable sutures versus absorbable suture anchors[J].Arthroscopy,2016,32(8):1639-1650.
[3] LEEBERG V,LEKDORF J,WONG C,et al.Tibial eminentia avulsion fracture in children-a systematic review of the current literature[J].Dan Med J,2014,61(3):A4792.
[4] HAPA O,BARBER FA,SÜNER G,et al.Biomechanical comparison of tibial eminence fracture fixation with high-strength suture,EndoButton,and suture anchor[J].Arthroscopy,2012,28(5):681-687.
[5] GRIFFITH JF,ANTONIO GE,TONG CW,et al.Cruciate ligament avulsion fractures[J].Arthroscopy,2004,20(8):803-812.
[6] MEYERS MH,MCKEEVER FM.Fracture of the intercondylar eminence of the tibia[J].J Bone Joint Surg Am,1970,52(8):1677-1684.
[7] 中华中医药学会.膝关节交叉韧带损伤[J].风湿病与关节炎,2013,2(5):78-80.
[8] LYSHOLM J,GILLQUIST J.Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale[J].Am J Sports Med,1982,10(3):150-154.
[9] GANS I,BALDWIN KD,GANLEY TJ.Treatment and management outcomes of tibial eminence fractures in pediatric patients:a systematic review[J].Am J Sports Med,2013,42(7):1743-1750.
[10] WHITE EA,PATEL DB,MATCUK GR,et al.Cruciate ligament avulsion fractures:anatomy,biomechanics,injury patterns,and approach to management[J].Emerg Radiol,2013,20(5):429-440.
[11] MCLENNAN JG.The role of arthroscopic surgery in the treatment of fractures of the intercondylar eminence of the tibia[J].J Bone Joint Surg Br,1982,64(4):477-480.
[12] JANG KM,BAE JH,KIM JG,et al.Novel arthroscopic fixation method for anterior cruciate ligament tibial avulsion fracture with accompanying detachment of the anterior Horn of the lateral meniscus:three-point suture fixation[J].Injury,2013,44(8):1028-1032.
[13] KOCHER MS,MICHELI LJ,GERBINO P,et al.Tibial eminence fractures in children:prevalence of meniscal entrapment[J].Am J Sports Med,2003,31(3):404-407.
[14] 陆振飞,赵金忠,皇甫小桥.关节镜下跨骺板8字缝线固定法治疗前交叉韧带胫骨止点撕脱骨折后的随访研究[J].中华小儿外科杂志,2007,28(12):639-643.
[15] 高庆峰,成雪,张磊,等.关节镜下规避骺板八字缝线固定法治疗儿童前交叉韧带胫骨止点撕脱骨折[J].中华小儿外科杂志,2014,35(10):746-750.
[16] BECK NA,PATEL NM,GANLEY TJ.The pediatric knee:current concepts in sports medicine[J].J Pediatr Orthop B,2014,23(1):59-66.

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备注/Memo

备注/Memo:
通讯作者:郭旗 E-mail:guoqi_nku@163.com
更新日期/Last Update: 2017-06-20