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[1]劉玉強(qiáng),郭旗,梁振雷,等.關(guān)節(jié)鏡下脛骨隧道法與骺板規(guī)避法縫線固定治療兒童前交叉韌帶脛骨止點撕脫骨折的比較研究[J].中醫(yī)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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關(guān)節(jié)鏡下脛骨隧道法與骺板規(guī)避法縫線固定治療兒童前交叉韌帶脛骨止點撕脫骨折的比較研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第29卷
期數(shù):
2017年06期
頁碼:
12-15,24
欄目:
臨床研究
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:
劉玉強(qiáng); 郭旗; 梁振雷; 王續(xù)鵬; 胡濱; 劉寧
河南省鄭州市骨科醫(yī)院,河南 鄭州 450052
Author(s):
LIU Yuqiang; GUO Qi; LIANG Zhenlei; WANG Xupeng; HU Bin; LIU Ning
Zhengzhou Orthopaedic Hospital,Zhengzhou 450052,Henan,China
關(guān)鍵詞:
前交叉韌帶;  脛骨;  撕脫骨折;  骨骺;  關(guān)節(jié)鏡檢查;  縫線;  兒童
Keywords:
Key words anterior cruciate ligament;  tibia;  avulsion fracture;  epiphyses;  arthroscopy;  sutures;  child
摘要:
目的:比較關(guān)節(jié)鏡下脛骨隧道法與骺板規(guī)避法縫線固定治療兒童前交叉韌帶脛骨止點撕脫骨折的臨床療效和安全性。方法:回顧性分析27例兒童前交叉韌帶脛骨止點撕脫骨折患者的病例資料,其中采用關(guān)節(jié)鏡下脛骨隧道法縫線固定15例,采用關(guān)節(jié)鏡下骺板規(guī)避法縫線固定12例。男20例,女7例; 年齡5～14歲,中位數(shù)10歲; 按Meyers-Mckeever脛骨止點撕脫骨折分型,Ⅱ型17例、Ⅲ型10例; 受傷至手術(shù)時間5～34 d,中位數(shù)14 d。分別比較術(shù)前和末次隨訪時2組患者的膝關(guān)節(jié)活動度、Lysholm膝關(guān)節(jié)評分和國際膝關(guān)節(jié)文獻(xiàn)委員會(the international knee documentation committee,IKDC)膝關(guān)節(jié)評分,并比較2組患者脛骨骺板損傷發(fā)生情況。結(jié)果:術(shù)前2組患者膝關(guān)節(jié)活動度、Lysholm膝關(guān)節(jié)評分、IKDC膝關(guān)節(jié)評分比較,組間差異均無統(tǒng)計學(xué)意義[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]。末次隨訪時,2組患者膝關(guān)節(jié)活動度、Lysholm膝關(guān)節(jié)評分、IKDC膝關(guān)節(jié)評分比較,組間差異均無統(tǒng)計學(xué)意義[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組患者膝關(guān)節(jié)活動度、Lysholm膝關(guān)節(jié)評分、IKDC膝關(guān)節(jié)評分均高于術(shù)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)。脛骨隧道法固定組4例術(shù)后出現(xiàn)脛骨近端持續(xù)輕度疼痛,1例術(shù)后13個月在骺板內(nèi)有骨橋形成; 骺板規(guī)避法固定組無脛骨骺板損傷表現(xiàn); 骺板規(guī)避法固定組脛骨骺板損傷發(fā)生率低于脛骨隧道法固定組(P=0.047)。結(jié)論:對于兒童前交叉韌帶脛骨止點撕脫骨折患者而言,關(guān)節(jié)鏡下脛骨隧道法與骺板規(guī)避法縫線固定在改善膝關(guān)節(jié)活動度、恢復(fù)膝關(guān)節(jié)功能方面無明顯差異,但骺板規(guī)避法固定較脛骨隧道法固定能更好地降低脛骨骺板損傷的風(fēng)險。
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.

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通訊作者:郭旗 E-mail:[email protected]
更新日期/Last Update: 2017-06-20