| 汪武祥,季贵柱,陈松,等.克氏针钢丝张力带内固定治疗膝关节后外侧不稳的腓骨头粉碎性骨折.骨科,2023,14(4): 297-302. |
| 克氏针钢丝张力带内固定治疗膝关节后外侧不稳的腓骨头粉碎性骨折 |
| Kirschner Wire Tension Band Internal Fixation in the Treatment of Comminuted Fibular Head Fracture with Posterolateral Instability of the Knee |
| 投稿时间：2022-11-29 |
| DOI：10.3969/j.issn.1674-8573.2023.04.001 |
| 中文关键词: 腓骨头粉碎性骨折 弓形骨折 克氏针 钢丝张力带 膝关节后外侧角损伤 |
| 英文关键词: Comminuted fracture of head of fibula Arch fracture Kirschner wire Steel wire tension belt Injury of posterolateral corner of knee joint |
| 基金项目:四川省科技厅科研基金资助项目（2013JY0103） |
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| 中文摘要: |
| 目的 探讨切开复位克氏针钢丝张力带内固定治疗膝关节后外侧不稳的腓骨头粉碎性骨折的临床疗效。方法 回顾性分析2018年8月至2021年7月我院收治的13例膝关节后外侧不稳的腓骨头粉碎性骨折病人的临床资料，男8例，女5例，年龄为24~63岁，平均42.7岁。受伤原因：交通事故伤7例，重物砸伤3例，高处坠落3例，均为单膝闭合性损伤。其中7例伴前交叉韧带损伤，5例伴后交叉韧带损伤，1例同时伴前交叉韧带、后交叉韧带和腓总神经损伤。伤后至手术时间为3~15 d，平均7.5 d。13例病人均一期取自体腘绳肌腱关节镜下重建损伤的交叉韧带，切开复位腓骨头粉碎性骨折后，克氏针钢丝张力带内固定。观察记录手术前后胫骨拨号试验外旋角度、膝关节内翻应力试验、膝关节活动度及术后并发症发生情况，根据国际膝关节文献委员会（International Knee Documentation Committee，IKDC）分级、Lysholm膝关节评分评价治疗前后关节功能。结果 术后所有病人均获得随访，随访时间为12~24个月，平均16.5个月。术后所有膝关节内翻应力阴性，切口11例甲级愈合，2例乙级愈合。腓骨头粉碎性骨折均愈合，愈合时间为18~28周，中位数20周。至末次随访，屈膝30°拨号试验胫骨外旋角度、屈膝90°拨号试验胫骨外旋角度较术前明显减小（1.46°±0.88° vs. 14.85°±1.77°、0.54°±0.66° vs. 16.08°±1.38°），Lysholm膝关节评分和IKDC分级较术前有明显改善，差异有统计学意义（P＜0.05）。术后12例病人膝关节活动度恢复正常，1例病人出现0~10°屈曲功能受限。未见内固定松动、感染、下肢静脉血栓形成、腓总神经损伤等并发症。1例术前伴腓总神经损伤病人，术后20个月末次随访时足背皮肤麻木症状明显改善。结论 采用克氏针张力带内固定治疗膝关节后外侧不稳的腓骨头粉碎性骨折，固定可靠，骨折愈合好，术后可早期开始功能锻炼，促进膝关节功能恢复。 |
| 英文摘要: |
| Objective To evaluate the clinical outcome of open reduction and Kirschner wire tension band internal fixation in the treatment of comminuted fracture of the fibular head with posterolateral instability of the knee joint. Methods The data of 13 patients, including 8 males and 5 females, aged 24-63 years, with an average age of 42.7 years, admitted between August 2018 and July 2021 with comminuted fracture of the fibular head and posterolateral instability of the knee, were analyzed retrospectively. Seven cases were caused by traffic accidents, 3 by fall of heavy objects, and 3 by fall from heights. All patients had a closed injury of one knee. Of these, 7 had anterior cruciate ligament injury, 5 had posterior cruciate ligament injury, and 1 had injuries to the anterior and posterior cruciate ligaments and common peroneal nerve. The time from injury to operation was 3-15 d (mean 7.5 d). For each patient, the injured cruciate ligament was reconstructed in one stage with the autologous hamstring tendon under an arthroscope. The fibular head was managed by open reduction and K-wire tension band fixation. The patient was assessed by tibia dial test, knee varus stress test, and examinations of the range of motion of the knee and postoperative complications. The joint function was graded following the International Knee Documentation Committee (IKDC) system and Lysholm knee joint rating scale. Results All patients were followed-up for 12-24 months (mean 16.5). After operation, the varus stress of all knees was negative; 11 incisions healed in grade A and 2 in grade B. All fibula heads healed normally in 18-28 weeks (median: 20). At the end of the follow-up, the tibial external rotation angle of the 30° knee flexion dial test and the tibial external rotation angle of the 90° knee flexion dial test (1.46°±0.88° vs. 14.85°±1.77°, 0.54°±0.66° vs. 16.08°±1.38°) were significantly reduced as compared with the preoperative values; the Lysholm knee joint score and IKDC grading were significantly improved as compared with the preoperative values. The differences (P＜0.05). Twelve patients had normalization of the range of motion of the knee, and one patient showed limited 0-10° flexion function. No patients had complications such as internal fixation loosening, infection, lower limb vein thrombosis, or common peroneal nerve injury. One patient with common peroneal nerve injury before operation reported obvious improvement of foot dorsum numbness at the last follow-up (20 months). Conclusion The data from these patients indicate Kirschner wire tension band fixation is an effective option for managing comminuted fracture of the fibular head with posterolateral instability of the knee. This technique is reliable, produces satisfactory fracture healing, and allows early functional exercise to facilitate recovery of the knee joint function. |
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