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目的探讨关节镜下钢丝解剖固定治疗儿童前交叉韧带(ACL)胫骨止点撕脱骨折的手术方法和临床疗效。方法选择2008年9月至2012年9月潍坊医学院附属益都中心医院收治并采用关节镜下钢丝固定治疗儿童前交叉韧带胫骨止点撕脱骨折13例,采用钢丝对前交叉韧带前内侧束止点和后外侧束止点均进行固定,达到解剖内固定。并通过术前及术后随访一般情况、Lachman试验及前抽屉试验,并采用Lysholm评分表进行膝关节功能的评估和疗效分析。结果术前13例患者Lachman试验、前抽屉试验均为阳性,术后末次随访均为阴性。术前及术后末次随访,Lysholm评分由术前的(46.9±2.7)分提高到(94.7±1.8)分,差异有统计学意义(P<0.05)。结论关节镜辅助下钢丝解剖固定治疗儿童前交叉韧带胫骨止点撕脱骨折,具有创伤小、能够有效恢复膝关节的前后向及旋转稳定性,更接近于ACL胫骨止点的解剖生物力学重建,固定牢固,可早期行关节功能锻炼,并发症少等优点,疗效满意。
Objective To investigate the surgical method and clinical efficacy of arthroscopic anastomosis and fixation of avulsion fractures of anterior cruciate ligament (ACL) in tibia. Methods Thirteen patients with avulsion fractures of the anterior cruciate ligament of the tibia were treated with arthroscopic wire fixation at Yidu Central Hospital Affiliated to Weifang Medical College from September 2008 to September 2012. The anterior cruciate ligament anterior medial bundle Stop point and posterolateral stop point are fixed to achieve anatomic internal fixation. The knee joint function evaluation and curative effect analysis were performed by the Lysman test and the front drawer test by the general conditions before and after follow-up. Results The Lachman test and the front drawer test were positive in all 13 patients before surgery. The last follow-up was negative. Preoperative and postoperative follow-up, Lysholm score increased from (46.9 ± 2.7) points to (94.7 ± 1.8) points, the difference was statistically significant (P <0.05). Conclusions Arthroscopically assisted wire anatomical fixation of anterior cruciate ligament tibial avulsion fractures in children with less trauma can effectively restore the anterior, posterior and rotational stability of the knee joint, and is closer to anatomic biomechanical reconstruction of ACL tibia. Fixed firmly, early joint function exercise, less complications, the effect is satisfactory.