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目的观察关节镜下AO空心拉力螺钉治疗儿童前交叉韧带胫骨止点撕脱性骨折的临床疗效,及空心拉力螺钉的数量选择。方法选取2005年9月至2012年9月收治的前交叉韧带胫骨止点撕脱性骨折(均为MeyersMekeeverⅡ型和Ⅲ型骨折)39例患儿,全部实施关节镜下AO空心拉力螺钉治疗,按照随机数字表法分为两组:2枚螺钉组(20例)术中采用2枚空心拉力螺钉,3枚螺钉组(19例)采用3枚空心拉力螺钉。进行为期3年的随访,末次随访时评价膝关节功能及其稳定性,随访中观察患肢生长发育异常的发生情况。观察患儿膝关节功能变化及患肢生长发育情况。结果两组患儿Lysholm评分、Tenger评分术前无明显统计学差异(P均>0.05),术后均较术前显著上升(P均<0.01),且末次随访时两组评分无明显统计学差异(P均>0.05);膝关节稳定性级别两组患儿术后均较术前显著上升(P均<0.01),末次随访时两组间比较差异无统计学意义(P>0.05);术后两组患儿膝关节功能恢复均良好,未见伤肢成角、短缩等发育异常情况发生。结论关节镜下AO空心拉力螺钉能够有效治疗儿童Ⅱ型、Ⅲ型前交叉韧带胫骨止点撕脱性骨折,其微创、内固定物可靠的优势有助于患儿早期功能恢复,且不会对其生长发育情况造成影响,应用2枚螺钉具有疗效可靠、操作便捷的优点。
Objective To observe the clinical efficacy of arthroscopic AO hollow screw in the treatment of avulsion fractures of the anterior cruciate ligament in children and the selection of hollow lag screws. Methods Thirty-nine cases of anterior cruciate ligament tibial avulsion fracture (both MeyersMekeever Ⅱ and Ⅲ fractures) who were treated from September 2005 to September 2012 were treated with arthroscopic AO hollow lag screw, Random number table is divided into two groups: 2 screws (20 cases) intraoperative use of two hollow lag screws, 3 screws (19 cases) using three hollow lag screws. A 3-year follow-up was performed. The knee joint function and stability were evaluated at the final follow-up. The incidence of abnormal limb growth and development was observed during follow-up. Observed changes in children’s knee function and limb growth and development. Results There was no significant difference in Lysholm score and Tenger score before operation between the two groups (all P> 0.05), and the postoperative scores were significantly higher than those before operation (all P <0.01). There was no significant difference between the two groups (P> 0.05). There was no significant difference between the two groups in postoperative follow-up (P> 0.05). The function recovery of knee joint in both groups was good after operation. No developmental abnormalities such as angulation and shortening of injured limb occurred. Conclusion AO hollow lag screw arthroscopy can effectively treat avulsion fractures of type II and III anterior cruciate ligament in tibia, and the reliable advantages of minimally invasive and internal fixators are helpful to the early recovery of children’s function, and will not Its growth and development have an impact, the use of two screws with reliable efficacy, easy operation advantages.