关节镜下两种钢丝内固定方法治疗胫骨髁间棘骨折的临床研究

发布时间：2018-10-31 10:47

【摘要】：目的:关节镜下经骨道及经软组织道两种钢丝内固定方法治疗胫骨髁间棘骨折的临床研究。方法:对2012年8月-2015年12月在济阳县中医院骨科收治的50例符合胫骨髁间棘骨折诊断标准的住院患者分别行膝关节镜下经骨道和经软组织道钢丝两种内固定方法,并进行总结。其中女性18例,男性32例,年龄9岁到45岁,左膝关节22例,右膝关节28例,胫骨近端骨骺未闭合10例。其中经骨道固定组20例,经软组织道固定组30例,其中骨骺未闭合者均采用经软组织道固定。术前及术后均采用Lysholm膝关节评分法进行评分,并分别行膝关节正侧位X片以明确骨折分型判断骨折的复位及愈合等情况,根据Lysholm评分及影像学资料评价经骨道及经软组织道两种内固定疗法的临床疗效。结果:1.本研究50例胫骨髁间棘骨折患者均在骨科门诊复查时进行随访调查,随访时间约6-12个月不等,平均约为9个月左右。在手术后3个月时复查患膝关节正侧位X线片,其报告均显示骨折线模糊,骨痂通过骨折线。在手术后6个月时复查膝关节正侧位X线片报告均显示骨折完全愈合,无畸形愈合,未见明显骨折线,无髁间窝撞击征象。术后6个月时患者门诊复查,对其进行膝关节稳定性检测,前抽屉实验,Lachman实验为阴性,两组无显著差异(P0.05)。2.两组在两组手术时间,止血带时间,住院时间方面,两组在手术时间,止血带应用时间,住院时间均无差异(P0.05)。3.两组术前Lysholm评分无显著差异,两组术后与术前相比具有统计学意义(P0.05),而术后两组Lysholm评分差异无统计学意义(P0.05)。4.两组骨折患者相关指标比较,治疗后,经骨道组优14例,良4例,可2例;软组织道组20例,良6例,可4例,两组优良率比较差异未见统计学意义(P0.05)。5.术后并发症的比较患者术后并发症的观察:50位患者术后门诊复查时,手术切口愈合情况皆为Ⅰ/甲,术后患者分别于1个月、3个月、6个月、9个月、12个月多次来门诊复查均未见深静脉血栓、关节内感染、关节僵直、创伤性关节炎等并发症。结论:关节镜下经骨道及经软组织道两种内固定方法治疗胫骨髁间棘棘骨折的两组手术效果比较无统计学意义,术后膝关节稳定性好,活动度良,患者感觉满意。两种手术方法对胫骨髁间棘骨折有良好的治疗作用。经软组织道固定方法尤其适用于骨骺未闭合的患者。
[Abstract]:Objective: to study the treatment of tibial intercondylar spine fracture by two kinds of wire internal fixation under arthroscopy. Methods: from August 2012 to December 2015, 50 inpatients who met the diagnostic criteria of tibial intercondylar spine fracture in Department of Orthopaedics, Jiyang traditional Chinese Medicine Hospital, were treated with internal fixation under knee arthroscopy and wire through soft tissue canal, respectively. And sum up. Among them, 18 cases were female, 32 cases were male, the age was 9 to 45 years old, 22 cases were left knee joint, 28 cases were right knee joint, 10 cases were unclosed proximal tibia epiphysis. There were 20 cases in the transosseous canal fixation group and 30 cases in the soft tissue canal fixation group. Lysholm knee scoring method was used before and after operation, and the anterior and lateral X ray films of knee joint were performed to determine the reduction and healing of the fracture. Lysholm score and imaging data were used to evaluate the clinical effect of transosseous and soft tissue canal fixation. The result is 1: 1. In this study, 50 cases of tibial intercondylar spine fracture were followed-up in orthopaedic outpatient clinic. The follow-up time ranged from 6 to 12 months, with an average of about 9 months. At 3 months after operation, the X-ray films of anterior and lateral position of knee joint were reexamined. The results showed that the fracture line was blurred and the callus passed through the fracture line. At 6 months after operation, X-ray examination showed complete union of the knee joint, no malunion, no obvious fracture line and no sign of impingement of intercondylar fossa. 6 months after the outpatient review, the knee stability test, anterior drawer test, Lachman test was negative, there was no significant difference between the two groups (P0.05). The operation time, tourniquet time, hospitalization time of the two groups in the two groups, the two groups in the operation time, tourniquet application time, hospitalization time were not different (P0.05). There was no significant difference in Lysholm scores between the two groups before operation (P0.05), but there was no significant difference in Lysholm scores between the two groups after operation (P0.05). After treatment, 14 cases were excellent, 4 cases were good, 2 cases were fair, 20 cases were good, 6 cases were good and 4 cases were fair in soft tissue canal group, there was no significant difference in excellent and good rate between the two groups (P0.05). Comparison of postoperative complications observation of postoperative complications: I / A was found in all of the 50 patients with postoperative outpatient reexamination, and the postoperative patients were 1 month, 3 months, 6 months, 9 months, respectively, and all of them were cured in 1 month, 3 months, 6 months and 9 months, respectively. There were no complications such as deep venous thrombosis, intraarticular infection, joint stiffness, traumatic arthritis and so on. Conclusion: there is no significant difference between the two groups in the treatment of tibial intercondylar spine fracture by arthroscopic internal fixation of bone canal and soft tissue canal. The postoperative knee joint is stable, the movement is good, and the patients feel satisfied. The two surgical methods have a good effect on the treatment of tibial intercondylar spine fracture. Soft tissue canal fixation is especially suitable for patients with unclosed epiphysis.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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