胫骨后交叉韧带止点撕脱骨折的诊断治疗体会

Experience in Surgical Treatment of Tibial Insertion Avulsion Fracture of Posterior Cruciate Iigament

目的：探讨后交叉韧带胫骨止点撕脱骨折的诊断、治疗。方法：回顾分析2002年6月至2006年3月共收治19例后交叉韧带胫骨止点撕脱骨折的诊断与治疗情况。运动损伤3例，交通事故伤14例，重物砸伤2例。行膝后内侧直切口或倒“L”，形切口，从腓肠肌内侧缘与半腱肌之间分离进入：分别采用钢丝、可吸收螺钉固定。术后6个月定期随访，了解骨折复位，愈合，膝关节的稳定性，活动度及惠肢功能恢复情况。结果：术后6周，骨折均愈合，无移位。术后6个月，所有患者后抽屉试验阴性，无伸膝受限，3例有10°～15°屈膝受限，平均屈膝活动度139°±3．7°。Lysholm膝关节功能评分为（92．2±3．4）分。结论：要认识到后交叉韧带胫骨止点撕脱骨折的危害性，做到早期正确的诊断，治疗；钢丝，可吸收螺钉固定可靠，避免二次手术创伤，是一种较好的选择。

Objective： To explore the diagnosis and treatment of tibial insertion avulsion fracture of posterior cruciate ligament. Methods- Nineteen cases of tibial insertion avulsion fracture of posterior cruciate ligament were reviewed during the time from Marth,2002 to June,2006. The causes of the injuries werw athletic damages for 3 cases, motorcycle crashes for 14 cases and weight harm for 2 cases. All cases operation were carried out through posteromedial portal with the avulsion bone fragments reduced and fixed by absorbable screws or wires . Fracture reduction and union ,knee stability, range of motiom, as well as the total knee function were evaluated. Results： All fractures were united without displacement. Six months postoperatively, negative posterior drawer test and knee extension restored to normal in all cases and average range of flexion were 139±3.7. 10to 15flexion limitation was found in 3 cases,The mean Lysholm knee score was 92.2± 3.4. Conclusion： It might be dangerous for tibial insertion avulsion fracture of posterior cruciate ligament and must be diagnosed and surgical treated .Wire or absorbable screw might be an ideal material for it＇s firm fracture fixation and without another procedure injury,