关节镜下儿童胫骨髁间棘骨折的微创治疗

摘要

目的:分析儿童胫骨髁间棘骨折的特点,介绍关节镜辅助下微创治疗的方法.方法:对2004年1月至2008年12月12例儿童胫骨髁间棘骨折进行回顾性分析.按照Meyers-McKeever骨折分型:Ⅰ型1例,Ⅱ型4例,Ⅲ型7例.新鲜骨折10例,陈旧骨折2例;男10例,女2例;年龄8～13岁,平均10岁.所有病例进行了关节镜探查、复位,克氏针固定.随访时间10～36个月,了解骨折愈合、关节活动度、膝关节稳定性等情况.合并半月板损伤1例,滑车区软骨损伤1例,半月板嵌入骨块下5例.结果:骨折愈合时间平均5周,无畸形愈合、骨不连,无髁间窝撞击表现.术后3个月Lysholm膝关节功能评分平均(92.7±2.5)分,术后6个月平均(96.4±1.7)分,所有患膝恢复健侧活动度.结论:儿童胫骨髁间棘骨折以Ⅱ、Ⅲ型多见,软骨及丰月板等关节内合并伤少见.关节镜辅助下交叉克氏针固定法操作简便、手术创伤小、恢复快,符合儿童骨生长快的特点.%Objective:To analyze the characteristics of children tibial intercondylar eminence fractures,and introduce arthroscopic minimally invasive techniques for the treatment of tibial intercondylar eminence fractures in children. Methods: From January 2004 to December 2008,12 children with tibial intercondylar eminence fractures were treated with cross Kirschner wire fixation after arthroscopic reduction. According to Meyers-McKeever classification systems, there were 1 case of type I ,4 cases of type H , and 7 cases of type M. There were 10 fresh and 2 old fractures in all. Among the patients, 10 patients were boy and 2 patients were girl,ranging in age from 8 to 13 years,with an average of 10 years. All the patients underwent arthroscopic exploration,reduction and fixation. During follow-up ranging from 10 to 36 months,the union of fracture,range of motion and stabilization of the knee were assessed. One patient was combined with lesions of the menisci, 1 patient with femoral trochlea cartilage injury,and 5 patients with meniscal entrapment under the bone. Results:The heeling time averaged 5 weeks. No knee laxity or instability and no intercondylar notch impingement was detected in all cases at 3 months postoperatively. At same time, full range of motion of the affected knee returned, and the average Lysholm knee score was (92.7±2.5), the average Lysholm knee score was (96.4±1.7) at 6 months postoperatively. The Lachman test and ADT test was negative. Conclusion: The type II and type 01 tibial intercondylar eminence fractures occur frequently in children. Lesions of the menisci and cartilage occur seldom. The method of arthroscopic cross Kirschner wire fixation for the treatment of tibial intercondylar eminence fracture is easy to operate. Simultaneously,this technique is less invasive and allows early recovery. Also it coincidences with the characteristic rapid bone growth of children.