关节镜下治疗前叉止点撕脱性骨折

Avulsion

Fracture

ofAnteriorCruciateLigament1History1875——Poncet1970——AvulsionfractureoftheACLwasclassifiedby

MeyersMH1996——VeselkoMperformed

arthroscopicplacementandremovalofcannulatedscrewforfixation2008——JinzhongZhaoreported

arthroscopicFigure-of-8suturefixationtechnique2Morbidity——3/10000014％of

ACL

injuryDistribution

of

age

children——8～14

years

old

old

women——over

40

years

oldAccidE-mergNurs，2004，12(3)：173-175．InternationalJournalofPediatrics,2012,ArticleID932702,6pages

epidemiology3Fallinjuryandtrafficaccident——51％Sportsinjuries——Skiingandfootball--14%TheKnee，2008，15(3)：164-167．4Associatedwithcapsuletear

of

meniscus

or

articularcapsule,sometimes

including

medialandlateralcollateralligamentinjuryorinjuryofarticularcartilageArthroscopy:TheJournalofArthroscopicandRelatedSurgery,2005,21(1):86-92.5Relevant

anatomicalstructure6Residentridge7Residentridge8Branchingridge9Footprints10Footprints1112Theanteriormedialbundleistightinflexion

theposteriorlateralbundleistightinthestraightposition1312损伤机制Youngpeople-kneeflexion,tibialinternalrotationAdults-hyperextensionofthekneeACLlimitsanteriordisplacement,hyperextension,andinternalrotation14DiagnosisInjury

history

of

hyperextensionofkneeBruise

and

hyphemaTheextensionwaslimitedAnterior

drawertestandLachmansignare

positiveX-ray

and

CT

are

conducivetounderstandingoffractureMRIishelpfultounderstandinjury

of

ACL,andothers

combinedinjury.15Anterior

drawertestandLachmansign16X-ray17CT18MRI19Meyers-McKeeverclassificationArthroscopy2005;21[1]:86-9220Howtoidentifyfreshoroldfracturesinimaging21TreatmentItypeConservativetreatment

to

keep

the

knee

in

a

functionalposition

for

6weeksⅡ

and

Ⅲ

types

Manipulation，iffail，selectedsurgeryⅣ

type

Surgery22Reduction

Thedrawertestafterextension23P-R-I-C–E

programProtectionRestIceCompressionElevate

24It

usedtobethemostcommonlytreatmentprogramtoopenreductionandfixedwithwire25AfailedcaseCase126Singletunnelfixationwithsteelwireandextrusionscrew27Noextrusionnailwasfoundbeforeoperationimpinge28Ifthefracturemassissmall,usingEthibondsuture29OldfractureofavulsionfractureofACLCase230Woundfreshness31Tocleanandremovealldead,damagedtissuearoundofthefracturemass32Tointroducethewirebyalumbarpunctureneedle33TothreadthroughNo.5Ethibond,andfixfracturewith"8"tensionband34Toinspectcarefully35Thepatientswerefollowedupfor1monthaftersurgery36Case3TousePDSiiasthethread37TousePDSiiasthethread38TousePDSiiasthethread39Case4OldavulsionfractureofACL40Withbonesclerosis,andACLstretchandtear41Theboneblockcannotberemovedwiththenucleuspulposusclampmicro-grindingdrilltodrill42ToremovebonemasswithnucleuspulposusforcepsEnlargementofthecondylarfossa43Thepicturewastakenafterreconstructionofanteriorcruciateligament44PostoperativeX-ray45followedupfor1monthaftersurgery46Forabiggerfractureblock,hollowscrewisagoodchoice47Lateralmeniscus(LM)isbeingpulledanddisplaced48Ifthefractureofthetibialplateauiscombined,firstofall,thefractureshouldbefixed49X-rayshowedACLavulsionfracturecombinedwithtibialplateaufractureCase450MRI51Tocheckthestabilityofkneejointbeforeoperation52TocarefullyexaminethecollapseofthelateraltibialplateauToreduceandfixtibialplateaufractures53ToremovethesynovialtissueofthefemoralcondyleArthroscopicimageofthereducefracture54TocutthetransverseligamentofmeniscusThereductionofthefracturemassisblockedbythetransverseligamentofthemeniscus55ToreducefractureTofixedfracturewithk-wiretemporarily56To

drill

intosecondK-wireAguidepinisinserted57To

screwintothehollowscrewTo

inspect

after

fixation58PostoperativeX-ray59