MINI OPEN联合膝关节镜治疗后交叉韧带胫骨止点撕脱骨折的疗效观察

Clinical observation on the curative effects of knee arthroscopy with mini open incision in the treatment of tibial avulsion fractures of the posterior cruciate ligament

目的观察小切口(mini open)联合膝关节镜治疗后交叉韧带胫骨止点撕脱骨折的临床疗效。方法 18例确诊后交叉韧带胫骨止点撕脱骨折患者,行膝关节镜辅助下联合胭窝后正中小切口切开复位治疗骨折,同时处理关节内合并损伤,术后予伸直位支具固定配合功能锻炼,术后定期随访并复查膝关节正侧位片,随访指标包括:关节稳定性,关节功能恢复情况及术后并发症、切口愈合情况;术前及术后1年行膝关节Lvsholm功能评分及IKDC功能评价。结果所有患者均获随访,随访时间13-21个月,平均15.4个月;术后复查膝关节正侧位X线片提示骨折复位良好,无骨折不愈合,行后抽屉试验及反Lachman试验阴性;3例患者诉上下台阶关节稍不适、研磨感,考虑与合并关节软骨损伤有关、余未见明显术后并发症,所有患者关节活动度恢复至伤前正常水平。术前膝关节Lysholm评分平均53.2分,术后1年膝关节Lysholm评分平均96.3分,术前与术后1年膝关节Lysholm评分数据行两组对照T检验,P<0.05,差异有统计学意义;末次随访时IKDC评分从术前全部明显异常(D级)改善至术后正常(A级)17膝、接近正常(B级)1膝。结论膝关节镜辅助下联合小切口治疗后交叉韧带胫骨止点撕脱骨折临床疗效确切,本组病例术后未发现明显并发症,患者关节功能恢复良好,且该手术方法简单、安全,可广泛推广、应用。

Objective To observe the curative effects of knee arthroscopy with mini open incision in the treatment of tibial avulsion fractures of the posterior cruciate ligament. Methods 18 patients who were diagnosed as tibial avulsion fractures of the posterior cruciate ligament had knee arthroscopy with mini open incision into the posteromedial popliteal fossa reduction, and meanwhile associated injuries of the knee joint were dealt with. After surgery the knees were fixed in straight position with orthosis, and regular functional exercises were performed. The patients were followed up regularly, and their AP X-ray films of the knee joint were reviewed after surgery. The follow- up indexes included joint stability, joint function recovery, incidence of complications and wound healing after surgery and preoperative and 1-year postoperative Lysholm score of the knee joint and International Knee Documentation Committee （IKDC） score. Results All patients were followed up for an average period of 15.4 months （range; 13- 21 months）. The AP X-ray films of the knee joint showed fractures healing well, without fracture nonunion. The posterior drawer test and negative Lachman test were performed. 3 patients felt a little uncomfortable with grinding sense when walking up and down stairs, which may be due to articular cartilage damage, and others felt well without significant postoperative complications. The mean Lysholm score of the knee joint improved from 53.2 preoperatively to 96.3 1 year after surgery. The Lysholm scores of the knee joint were compared in 2 groups by t-test, and the differences were statistically significant （P〈0.05）. In the latest follow-up, the IKDC score improved from the obvious abnormal state preoperatively （grade D） to the normal knee 17 （grade A）, and even close to the normal knee 1 （grade B） postoperatively. Conclusions The curative effects of knee arthroscopy with mini open incision in the treatment of tibial avulsion fractures of the posterior cruciate ligament are predominant. Normal knee function is restored, without significant complications after surgery. Moreover the therapy is simple and safe, which can be used extensively.