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目的比较关节镜下空心钉和8字缝线内固定治疗儿童胫骨髁间棘撕脱骨折的疗效。方法回顾性分析自2009-03—2013-10诊治的22例儿童胫骨棘撕脱骨折的临床资料。12例采用空心钉内固定(空心钉组),10例采用8字缝线固定(缝线组)。采用膝关节活动范围、韧带松弛情况、Lysholm、IKDC评分评估2组术后膝关节功能。结果空心钉组手术时间为(59.62±5.78)min,缝线组为(77.81±11.08)min,空心钉组手术时间少于缝线组,差异有统计学意义(t=-4.718,P=0.006)。2组均获随访,空心钉组获得随访1.3~3.7(2.80±0.72)年,缝线组获得随访0.9~3.5(2.14±0.91)年。2组术后切口均一期愈合,术后3个月均获得骨性愈合。末次随访时2组膝关节活动度恢复正常,前抽屉试验均呈阴性,Lachman试验仅空心钉组1例阳性,但终点为阴性。空心钉组和缝线组Lysholm评分分别为(94.23±2.71)分和(93.20±1.55)分;IKDC评分分别为(93.73±1.96)分和(92.90±2.41)分。2组Lysholm评分、IKDC评分间差异均无统计学意义(P>0.05)。结论关节镜下采用空心钉和8字缝线固定治疗儿童胫骨髁间棘止点撕脱骨折均可获得较好疗效,但8字缝线应用范围广、手术风险小、费用较低。
Objective To compare the curative effect of arthroscopic hollow screws and 8-suture internal fixation for avulsion fractures of tibial intercondylar eminence in children. Methods The clinical data of tibial spine avulsion fracture in 22 children who were diagnosed and treated from March 2009 to October 2013 were retrospectively analyzed. Twelve cases were treated with cannulated screw fixation (cannulated screw group), and 10 cases were fixed with 8-suture fixation (suture fixation). Knee joint activity range, ligament laxity, Lysholm, IKDC score were used to evaluate the postoperative knee joint function. Results The operation time of the hollow nail group was (59.62 ± 5.78) min, the suture group was (77.81 ± 11.08) min, the operation time of the hollow nail group was less than that of the suture group, the difference was statistically significant (t = -4.718, P = 0.006 ). All the patients were followed up for 1.3 to 3.7 (2.80 ± 0.72) years in the hollow nail group and 0.9 to 3.5 (2.14 ± 0.91) years in the suture group. All the incisions were healed in one time and bony union was achieved in 3 months after operation. At the last follow-up, the knee mobility of two groups returned to normal, and the negative drawer test was negative. In the Lachman’s test, only one case of the hollow nail group was positive, but the end point was negative. The Lysholm scores of the hollow nail group and the suture group were (94.23 ± 2.71) and (93.20 ± 1.55) points respectively; the IKDC scores were (93.73 ± 1.96) and (92.90 ± 2.41) points respectively. There was no significant difference in Lysholm score and IKDC score between the two groups (P> 0.05). Conclusion Hollow nail and 8-suture fixation for children with tibial intercondylar eminence avulsion fractures under arthroscopy can achieve a good effect, but the wide range of 8-suture suture, the risk of surgery is small, the cost is low.