关节镜下复位固定儿童前交叉韧带胫骨止点撕脱骨折&#x02014;&#x02014;腰穿套管针辅助经骨隧道缝线&#x0201c;8&#x0201d;字固定技术

代朋乙; 常祺; 王战朝

doi:10.3969/j.issn.2097-5457.2025.01.002

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运动科学与健康研究 ›› 2025, Vol. 1 ›› Issue (1) : 61-66. DOI: 10.3969/j.issn.2097-5457.2025.01.002

临床及训练实践

关节镜下复位固定儿童前交叉韧带胫骨止点撕脱骨折——腰穿套管针辅助经骨隧道缝线“8”字固定技术

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Arthroscopic reduction and fixation for tibial insertion avulsion fracture of anterior cruciate ligament （ACL） in children—Lumbar puncture needle-assisted“8” suture technique through bone tunnel

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摘要

目的： 探讨关节镜下腰穿套管针辅助经骨隧道缝线“8”字复位固定儿童前交叉韧带胫骨止点撕脱骨折的手术方法和疗效。方法： 选择2019年3月~2023年3月行关节镜下腰穿套管针辅助经骨隧道缝线“8”字复位固定治疗的前交叉韧带胫骨止点撕脱骨折的儿童病例36例（36膝）,术前Meyers-McKeever-Zaricznyj分型Ⅱ型13例、Ⅲ型17例、IV型6例,均为新鲜骨折。术后X线检查骨折复位愈合情况,比较手术前后Lysholm评分及IKDC评分。记录手术相关并发症。结果： 术后随访13~25（15.1±3.6）个月,术后3个月X线片示骨折均愈合;术后6个月、末次随诊Lysholm评分、IKDC评分均高于术前（P<0.05）,但术后两时间点相比无差异（P>0.05）;未发生缝线松动、断裂及关节畸形等并发症。结论： 关节镜下腰穿套管针辅助经骨隧道缝线“8”字复位固定儿童前交叉韧带胫骨止点撕脱骨折具有创伤小、固定可靠、利于骨折早期愈合、膝关节功能恢复良好等优点,临床效果满意。

Abstract

Objective: To investigate the surgical technique and efficacy of arthroscopic reduction and “8” suture fixation for tibial insertion avulsion fractures of anterior cruciate ligament (ACL) in children assisted by Lumbar puncture needle through bone tunnel. Methods: From March 2019 to March 2023, 36 cases (36 knees) of tibial insertion avulsion fractures of ACL treated with arthroscopic reduction and “8” suture fixation through bone tunnel. Preoperatively, there were 13 cases of type Ⅱ, 17 cases of type Ⅲ, and 6 cases of type IV according to theMeyers-McKeever-Zaricz-yj classification, all of which were fresh fractures. Postoperative X-ray examinations were conducted to assess fracture reduction and healing. Lysholm and IKDC scores were compared between preoperation and postoperation. Surgical-related complications were recorded. Results: Postoperative follow-up was conducted for 13 to 25 (15.1 ±3.6) months. Radiographs at three months postoperatively showed complete fractures healing. At six months after surgery and at the last follow-up, Lysholm scores and IKDC scores were higher than preoperative respectively (P<0.05), but there was no significant difference between the two time points (P>0.05). No complications such as suture loosening, rupture, or joint deformity occurred. Conclusion: Arthroscopic reduction and “8” suture fixation for tibial insertion avulsion fractures of ACL in children assisted by Lumbar puncture needle through bone tunnel can offer advantages such as minimal trauma, reliable fixation, early fracture healing, and good recovery of knee joint function, yielding satisfactory clinical outcomes.

导出引用

代朋乙, 常祺, 王战朝. 关节镜下复位固定儿童前交叉韧带胫骨止点撕脱骨折——腰穿套管针辅助经骨隧道缝线“8”字固定技术[J]. 运动科学与健康研究, 2025, 1(1): 61-66 https://doi.org/10.3969/j.issn.2097-5457.2025.01.002

Dai Pengyi, Chang Qi, Wang Zhanchao. Arthroscopic reduction and fixation for tibial insertion avulsion fracture of anterior cruciate ligament （ACL） in children—Lumbar puncture needle-assisted“8” suture technique through bone tunnel[J]. Research on Sports Science and Health, 2025, 1(1): 61-66 https://doi.org/10.3969/j.issn.2097-5457.2025.01.002

中图分类号： R615

参考文献

[1] COYLE C, JAGERNAUTH S, RAMACHANDRAN M.Tibial eminence fractures in the paediatric population: a systemic review[J]. J Child Orthop, 2014, 8(2): 149-159.
[2] MCCOY J S, NELSON R.Avulsion Fractures[M]. Treasure lsland (FL): StatPearls Publishing, 2023.
[3] MITCHELL JJ, MAYO MH, AXIBAL De, et a1. Delayed anterior cruciate ligament reconstruction in yong patients with previous anterior tibial spine fractures[J]. Am, Sports Med, 2016, 4(8): 2047-2056.
[4] MEYERS M H. MCKEEVER F M.Fracture of the intercondylar eminence of the tibia[J]. J Bone Joint Surg Am, 1970, 52(8): 1677-1684.
[5] ZARICZNYJ B.Avulsion fracture of the tibial eminence: treatment by open reduction and pining[J]. J Bone Joint Surg Am, 1977, 59(8): 1111-1114.
[6] 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.
[7] IRRGANG J J, ANDERSON A F, BOLAND A L, et al.Development and validation of the international knee documentation committee subjective knee form[J]. Am J Sports Med, 2001, 29(5): 600-613.
[8] ADAMS A J, TALATHI N S, GANDHI J S, et al.Tibial spine fractures in children: evaluation, management, and future directions[J]. J Knee Surg, 2018, 31(5): 374-81.
[9] STALLONE S, SELLERI F, TRISOLINO G, et al.Good subjective outcomes, stable knee and high return to sport after tibial eminence avulsion fracture in children[J]. Children, 2020, 7: 173.
[10] KRISTINSSON J, ELSOE R, JENSEN H P, et al.Satisfactory outcome following arthroscopic fixation of tibial intercondylar eminence fractures in children and adolescents using bioabsorbable nails[J]. Arch Orthop Trauma Surg, 2021, 141: 1945-51.
[11] D’ AMBROSIOA, SCHNEIDER L, BUND L, et al.Anatomical fixation of tibial intercondylar eminence fractures in children using a threaded pin with an adjustable lock[J]. Orthop Traumatol Surg Res, 2021: 108(6):103021.
[12] CALLANAN M, ALLEN J, FLUTIE B, et al.Suture versus screw fixation of tibial spine fractures in children and adolescents: a comparative study[J]. Orthop J Sports, 2019, 7(11):2325967119881961.
[13] BOUTSIADIS A, KARATAGLIS D J, AGATHANGELIDIS F J, et a1. Arthroscopic 4-point suture fixation of anterior cruciate ligament tibial avulsion fractures[J]. Arthroscopy Tech, 2014, 24(3): e683-e687.
[14] OOHASHI Y.A simple technique for arthroscopic suture fixation of displaced fracture of the intercondy of the tibial using folded surgical steels[J]. Arthroscopy, 2001J 17(8): 1007-1009.
[15] 代朋乙, 黄昌林. 关节镜下经髌内侧入路空心钉固定治疗前交叉韧带胫骨止点撕脱骨折的疗效[J]. 解放军医学杂志, 2018, 43(12): 1049-1053.
[16] 高士基, 刘宁. 关节镜下“8”字缝线与网兜缝线固定治疗前十字韧带胫骨止点撕脱骨折[J]. 中华骨科杂志, 2020, 40(3): 146-153.
[17] 刘飞, 侯华成, 鞠黎, 等. 关节镜下带孔克氏针辅助缝线固定胫骨髁间嵴骨折的临床疗效[J]. 中华实用儿科临床杂志, 2023, 38(9): 693-697.
[18] FLYNN JM, SKAGGS D L, WATERS P M.洛克伍德 -威尔金斯儿童骨折: 第8版[M]. 颉强, 赵黎, 杨建平, 译. 8版. 北京: 北京大学医学出版社, 2019: 976.
[19] SINHA S, MEENA D, NAIK A K, et al.Arthroscopic fixation of tibial spine avulsion in skeletally immature: the technique[J]. J Orthop Case Rep, 2017, 7(6): 80-84.
[20] CHALOPIN A, GEFFROY L, DECANTE C, et al.Arthroscopic suture fixation of anterior tibial intercondylar eminence fractures by retensioning of the ACL and hollowing of the bibial footprint: Objective and subjective clinical results in a paediatric population[J]. Orthop Traumatol Surg Res, 2022, 108(6): 103270.