比较关节镜下缝线套扎方法和可吸收带线锚钉方法治疗前交叉韧带胫骨止点撕脱骨折的临床疗效。

选取2012年6月至2018年2月解放军总医院第一医学中心骨科收治的62例损伤3周以内、伤前患肢功能正常的前交叉韧带胫骨止点撕脱骨折患者为研究对象，同时排除伴有开放性骨折、多发骨折或胫骨平台、半月板及韧带损伤的患者。根据手术方法不同将其分为两组，其中关节镜下应用缝线套扎方法治疗30例患者，关节镜下应用可吸收锚钉方法治疗32例患者。比较两组患者的手术时间、术中出血量；通过前抽屉试验、Lachman试验(屈膝30°前抽屉试验)、轴移试验检查比较两组患者膝关节稳定性；通过Lysholm评分、国际膝关节文献委员会(IKDC)2000膝关节功能主观评分比较两组患者膝关节功能情况。计量资料组间比较采用独立样本t检验，组内比较采用配对t检验，计数资料组间比较采用卡方检验。

两组患者手术切口均一期愈合，术后3个月X线检查示髁间嵴撕脱骨折均愈合。缝线套扎组随访13～42个月，平均(22±8)个月；可吸收锚钉组随访12～39个月，平均(19±7)个月。可吸收锚组手术时间低于缝线套扎组，差异有统计学意义(t＝2.491，P <0.05)，两组术中出血量差异无统计学意义(t＝1.506，P>0.05)。两组患者术后6个月Lysholm评分较术前提高，差异有统计学意义(缝线套扎组：t＝26.265，P<0.05；可吸收锚钉组：t＝29.857，P<0.05)，两组患者术后IKDC 2000膝关节功能主观评分较术前提高，差异有统计学意义(缝线套扎组：t＝35.619，P <0.05；可吸收锚钉组：t＝37.004，P<0.05)，术后6个月两组患者膝关节前抽屉试验、Lachman试验、轴移试验及Lysholm评分、IKDC 2000评分差别无统计学意义(P>0.05)。

关节镜下缝线套扎方法与可吸收锚钉方法治疗胫骨髁间嵴撕脱性骨折各有其特点，但临床治疗效果相同，均能够实现骨折块有效复位、牢固固定以及骨折愈合，有效恢复患肢功能，获得良好疗效。

To compare clinical outcomes of arthroscopic therapy for tibial eminence avulsion fracture with loop ligature suture and absorbable suture anchor.

From June 2012 to February 2018 62 patients with avulsion fractures of the anterior cruciate ligament injured within three weeks in First Medical Center of PLA General Hospital were selected in the study. All the affected knees have normal function before injury. The patients with open fracture, multiple fracture, tibial plateau fracture, meniscus and ligament injury were excluded in the study. All the patients were divided into two groups according to different operation methods: 30 patients were treated with arthroscopic reduction and fixation using loop ligature suture, as the suture group; 32 patients were treated with arthroscopic reduction and fixation using absorbable suture anchor, as the anchor group. The operation time and intraoperative blood loss of the two groups were compared. Knee joint stability of two groups was compared by front drawer test, Lachman test and axial shift test. Knee joint function of two groups was compared by Lysholm score and International Knee Documentation Committee (IKDC) 2000 subjective score. The independent sample t test was used to compare the quantitative data between two groups. The paired t test was used to compare the quantitative data within groups, and the chi-square test was used for compare the qualitative data between the two groups.

All the incisions healed primarily. Radiographic evaluation showed bone union within three months postoperatively in both groups. The mean follow-up period after the operation was (22±8)months in suture group and (19±7)months in anchor group. The operation time in anchor group was lower than that in suture group, and the difference was statistically significant (t=2.491, P<0.05). There was no significant difference of intraoperative blood loss between two groups (t=1.506, P>0.05). The Lysholm score were both improved in two groups after operation for six months. The difference was statistically significant(suture group: t=26.265, P<0.05; anchor group: t=29.857, P<0.05). The IKDC 2000 subjective scores were both improved in two groups after operation for six months.The difference was statistically significant(suture group: t=35.619, P<0.05; anchor group: t=37.004, P<0.05). There was no significant difference in anterior drawer test, Lachman test, pivot shift test, Lysholm score and IKDC 2000 subjective scores between two groups after operation for six months (P>0.05).

In the arthroscopic therapy for tibial eminence avulsion fracture, the loop ligature suture fixation and absorbable suture anchor fixation have their own characteristics but equivalent clinical effects, which could both provide satisfying reduction, rigid fixation, well healing of avulsed fragment and effective functional rehabilitation.