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目的探讨经膝前小切口置入带线锚钉治疗儿童前交叉韧带胫骨止点撕脱性骨折的临床疗效。方法采用经膝前小切口置入带线锚钉治疗17例前交叉韧带胫骨止点撕脱性骨折患儿,术中劈开髌韧带,经膝前小切口直视下复位骨折块,在胫骨结节内侧置入带线锚钉,用锚钉线缝扎固定骨折块,固定线两端在前交叉韧带前方“8”字交叉后经胫骨前方引出打结固定,避免钻骨隧道对骺板造成损伤。采用前抽屉试验、Lachman试验及轴移试验评价膝关节稳定性,根据Lysholm、Tegner膝关节评分标准评价膝关节功能恢复情况。结果 17例患儿均顺利完成手术,术中均未发生医源性神经血管损伤并发症,术后未出现切口感染并发症。患儿获得随访6~25个月,骨折均复位满意、无移位,前抽屉试验、Lachman试验及轴移试验均呈阴性,屈伸活动无受限,骨骺发育未受到影响。术前Lysholm、Tegner膝关节评分分别为16~46(33.29±9.27)分、3~5(4.00±0.86)分,术后末次随访时分别为97~100(97.94±0.82)分、7~9(7.76±0.75)分,手术前后比较差异均有统计学意义(P<0.05)。结论经膝前小切口置入带线锚钉治疗儿童前交叉韧带胫骨止点撕脱性骨折的手术操作简单易行,具有创伤小、恢复快、复位固定可靠、术后并发症少、膝关节功能恢复好等优点,同时又避免了钻骨隧道对骺板造成损伤,杜绝了因骨骺损伤引起的生长发育异常,值得临床推广。
Objective To investigate the clinical effect of inserting anterior small bolt incision into the anchorage of anterior cruciate ligament tibial avulsion fractures. Methods 17 cases of avulsion fractures of the anterior cruciate ligament with tibial anchorage were treated with a small anterior knee incision. The patellar ligament was dissected during operation. The fracture was reconstructed under direct anterior knee incision. Nodules placed inside the anchor line with anchor suture suture fixation fracture fragments, both ends of the anterior cruciate ligament fixation in front of the cross after the tibia leads to tie the knot fixed to avoid drilling the tunnel Epiphyseal plate damage. The drawer test, Lachman test and axial shift test were used to evaluate the stability of knee joint. The functional recovery of knee joint was evaluated according to Lysholm and Tegner knee score criteria. Results 17 cases of children were successfully completed surgery, no intraoperative iatrogenic neurovascular injury complications, incision infection did not occur after the complication. The children were followed up for 6 to 25 months. All the fractures were satisfactorily reset with no displacement. The front drawer test, Lachman test and axial shift test showed negative results. The flexion and extension activities were not restricted and the epiphyseal development was unaffected. The preoperative Lysholm and Tegner knee scores were between 16 and 46 (33.29 ± 9.27) and 3 to 5 (4.00 ± 0.86) points, respectively. The final follow-up was 97-100 (97.94 ± 0.82) and 7-9 (7.76 ± 0.75) points, the difference was statistically significant before and after surgery (P <0.05). Conclusion Surgical operation of pedicle screw fixation of anterior cruciate ligament tibial avulsion fractures with small anterior incision is simple and easy to operate. It has the advantages of less trauma, faster recovery, reliable fixation, less postoperative complications, less knee joint Good function recovery and other advantages, while avoiding the drill bone tunnel damage to the epiphyseal plate, put an end to the growth and development due to epiphyseal damage caused by abnormal, worthy of clinical promotion.