Arthroscopic Internal Fixation By Using Kirschner Wire For Tibial Eminence Fracture Surgical Design And Observational

Background and ObjectiveTibial eminence fractures in children and adolescents in multiple sports injuries,as the higher incidence is 8 to 14 years, the front of the Intercondylar spine is a higher incidence, Generally believed that children and adolescents has not been fully eminence region of ossification,When the external violence is high, causing cartilage or cartilage ligaments stretch under the cancellous bone avulsion injury.In adult, department of ossification is fully and less occurrence of tibial eminence fractures.Tibial eminence is the ligament attachment points, incorrect treatment can lead to future knee instability, and secondary to intra-articular major structural damage,seriously affecting the knee function.Arthroscopy has replaced the previous open surgery, but the rest of the world's fixation on fracture there is a big difference, each with its advantages and disadvantages,suture fixation is poor solid; wire fixed easily broken, remove the difficulties; and screws easy to damage the epiphysis,and these are mostly single fixed-fixed, solid is poor.This research comprehensive analysis of the advantages and disadvantages of various fixation methods,According to the clinical analysis, using 1.5mm Kirschner wire to fixation eminence fracture.①1.5mm Kirschner wire has good flexibility and toughness, less prone to fracture after fixation;②multi-dimensional cross-pin fixation to avoid fracture of the block rotation displacement;③Locator guided Kirschner wire in the accurate positioning, step in place which make joint injury Small;④1.5mm Kirschner wire is smaller which limiting the size of a small fracture fragments;⑤irschner wire fracture 70 to 80 degree bend is easy to operate fixed, Kirschner wire fixation of both ends of the double-solid, the second operation to remove the internal fixation Can be carried out under local anesthesia, without sre-entering the joint cavity;⑥Surgery costs less.Based on the above advantages, arthroscopic internal fixation by using Kirschner wire for tibial eminence fracture surgical design, and systematic review, statistical analysis of this and previous surgical, arthroscopy of the eminence fractures were fixed with absorbable screws Way comparison to the clinical treatment of intercondylar eminence fracture to provide a new effective, reliable fixation of fractures of the surgical approach, and to guide clinical application.Object and methodsTo collect our hospital department of orthopedic eminence fractures were 68 cases in 2009.7-2010.12,Under the arthroscopic to 68 patients who above typeⅡeminence fractures clean-up the joint, with the nucleus pulposus forceps slightly deepen the bone bed 1～2mm and get rid of the influence factors of fracture restoration, fracture block right reset,In fork ligament locator positioning, with 1.5 mm Kirschner wire 2-4 root from within the tibia nodules vertex fracture ends next drilling to fixation condylar fractures between block, Kirschner wires were fixed at both ends and determine the fracture is correct reset and stable fixation.Postoperative guide patients positive and effective rehabilitation exercise,And with our orthopedic 55 cases patients who have eminence fracture fixation with absorb the screws during 2008.6～2009.5 statistical analysis.Above participants according to the strict into and exclusion standard elected this study.Statistics by SPSS 16.0 statistical analysis software for processing, measurement data with x±s, Between the two groups were compared by T test.With P<0.05 defined as the difference was statistically significant.Results:1.Lysholm knee scoring system Results:The experimental group preoperative Lysholm knee scoring system score (40.66±12.99) increased to after (92.82±5.3O), preoperative and postoperative difference was statistically significant (P<0.05) control group Lysholm knee scoring system before surgery (36.82±13.81) increased to after (88.25±4.54), which is significantly (P<0.05). The experimental group and control group preoperative and postoperative scores were no significant statistical difference (P> 0.05).2.Gait Analysis Results:The experimental group time to distance index and kinematics index compare with control group are no significant differences (P> 0.05).3.physical examination (Lachman, drawer experiment, shaft move experiment, check limb swelling, pain degrees,range of motion):postoperative examinations were negative, range of motion improved significantly. External rotation of the dial-up test after the experimental group to improve the external rotation angle of 20.1 degrees, the experimental group and control group were not significantly different (P> 0.05).4.All patients undergo postoperative X-ray film, showing the fracture healed and fracture line fuzzy, all fracture healed, without Kirschner wire breakage.Conclusions:1.Arthroscopic internal fixation by using Kirschner wire for tibial eminence fracture time is short, less damage to the joints, postoperative rapid recovery, less the cost of surgery,knee activity, stability and overall functional recovery was satisfactory.2.Kirschner wire is good eminence fracture fixation, with good flexibility and toughness, not easy broken; multi-pin fixed interchange, avoiding the rotation displacement of fractures of the block; fixation fractures in one step, reducing the Joint injury; 1.5mm Kirschner wire size limit of small fracture fragments, fixation with Kirschner wire at both ends of double-solid, its easy to take the internal fixation of secondary surgery.