儿童髁间隆突撕脱骨折关节镜下复位固定术式的比较评估

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论证。胫骨髁间隆突撕脱骨折是一种罕见的损伤，主要发生于8至14岁的青少年，若骨折愈合不良， 可能导致致残。针对该类骨折，现已开发多种手术治疗方法，采用多种胫骨髁间隆突骨块固定方式。

目的。确定作者开发的在保留生长板条件下治疗Meyers–McKeever–Zaritsky III型胫骨髁间隆突撕脱骨折患者的手术方法的疗效，并将其与采用关节镜辅助下Herbert螺钉固定胫骨髁间隆突骨块的治疗结果进行比较。

材料与方法。分析45例年龄14–17岁的儿童胫骨髁间隆突骨折患者的术后功能结果，随访时间为术后3、6、12个月。A组包括22名儿童，采用关节镜辅助下使用Herbert螺钉固定髁间隆突骨块；B组包括23名儿童，采用作者开发的关节镜辅助下自锁环固定技术。

结果。B组患者的膝关节前后稳定性及旋转稳定性均优于A组。B组患者术后根据IKDC 2000评分、 Lysholm Knee Scoring Scale及Tegner评分进行的膝关节功能评估结果与A组相比，在统计学上具有显著差异，且表现更好，p=0.00006。A组患者在术后期间并发症发生率为18.1%（p≤0.05），包括螺钉断裂4.5%和异物反应性无菌性滑膜炎13.6%。B组患者未记录到术后并发症（p<0.05）。

结论。作者开发的在儿童保留生长板条件下的胫骨髁间隆突骨折固定方法，比Herbert螺钉固定更可靠和安全，可推荐用于临床应用。

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作者简介

Marsel R. Salikhov

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: virus-007-85@mail.ru
ORCID iD: 0000-0002-5706-481X
SPIN 代码: 2009-4349

MD, PhD, Cand. Sci. (Medicine)

俄罗斯联邦, Saint Petersburg

Vladislav V. Avramenko

Saint Petersburg State Pediatric Medical University

Email: avramenko.spb@mail.ru
ORCID iD: 0000-0003-0339-6066
SPIN 代码: 4632-9953

MD

俄罗斯联邦, Saint Petersburg

Gleb E. Batalov

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: Batalovgl@yandex.ru
ORCID iD: 0009-0006-5266-8530

MD

俄罗斯联邦, Saint Petersburg

Vadim V. Kemkin

Saint Petersburg State Pediatric Medical University

编辑信件的主要联系方式.
Email: vkemkin@mail.ru
ORCID iD: 0009-0002-7101-906X

MD

俄罗斯联邦, Saint Petersburg

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2. Fig. 1. Computed tomography scan of a patient with a right tibial intercondylar eminence fracture: (a) coronal view; (b) sagittal view.

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3. Fig. 2. Tibial guide placement during anterior cruciate ligament reconstruction. БК, femur; ББК, tibia; 1, anterior cruciate ligament; 2, working tip of the guide placed at the center of the tibial eminence fragment; 3, tibial guide from a standard ACL reconstruction set, positioned at a 55° angle relative to the tibial plateau.

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4. Fig. 3. Passage of the 2.5-mm guidewire. The distal guidewire tip exited in the anterior intercondylar area of the tibia: БК, femur; ББК, tibia; 1, anterior cruciate ligament; 2, distal tip of the guidewire emerging in the anterior intercondylar area of the tibia via the center of the tibial eminence fragment; 3, tibial guide from a standard ACL reconstruction set positioned at a 55° angle relative to the tibial plateau; 4, guidewire.

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5. Fig. 4. Arthroscopic passage of the free ends of the self-tightened suture loop through the guidewire eyelet. БК, femur; ББК, tibia; 1, intra-articular plate attached to the self-tightened suture loop; 2, free ends of the suture loop inserted through the guidewire; 3, guidewire with a preloaded shuttle suture.

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6. Fig. 5. Image of the implant (self-tightening suture loop with a plate) placed over the tibial intercondylar eminence fragment: 1, free ends of the self-tightening suture loop; 2, intra-articular plate fixed on the self-tightening suture loop; 3, self-tightening suture loop.

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7. Fig. 6. Insertion of the self-tightening suture loop through the tibial tunnel. БК, femur; ББК, tibia; 1, an intra-articular plate positioned over the tibial eminence fragment; 2, self-tightening suture loop emerging from the tibial tunnel.

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8. Fig. 7. A second plate affixed externally as a component of the suture loop system. БК, femur; ББК, tibia; 1, intra-articular plate positioned over the tibial eminence fragment; 2, extra-articular plate attached to the suture loop.

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9. Fig. 8. Image of the implant (self-tightening suture loop between two plates). 1, self-tightening suture loop; 2, intra-articular plate affixed to the self-tightening suture loop; 3, extra-articular plate.

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10. Fig. 9. Final fixation employing the self-tightening suture loop and two extra-articular plates. БК, femur; ББК, tibia; 1, intra-articular plate placed over the tibial eminence fragment; 2, extra-articular plate; 3, free ends for tightening the suture loop.

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11. Fig. 10. Reduced and fixed tibial eminence fracture as seen on arthroscopy. 1, fixed TIE fragment; 2, intra-articular plate; 3, anterior cruciate ligament.

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