经膝后正中小切口可吸收螺钉固定治疗后交叉韧带胫骨止点撕脱骨折

Absorbable screw fixation for the treatment of tibial avulsion fracture of the tibial attachment of the posterior cruci ate ligament through posterior middle mini incision of knee joint

目的：探讨经膝后正中小切口可吸收拉力螺钉固定治疗后交叉韧带胫骨止点撕脱骨折的方法和临床疗效.方法：对2007年1月至2011年12月应用可吸收螺钉治疗后交叉韧带胫骨止点撕脱骨折的50例患者资料进行回顾性分析.其中男38例,女12例;年龄18～62岁,平均36.8岁;病程1～52周.术中采用膝关节后正中小切口,注意保护血管神经.术后通过物理检查、Lysholm及IKDC评分来评价手术疗效.结果：术中无断钉,术后无感染、窦道形成、骨折块移位等并发症发生,仅1例切口愈合延迟.随访6～42个月,平均30个月,终末随访时患者均获骨性愈合.2例因未及时复诊出现膝关节活动受限.50例术膝后抽屉试验及Lachman征为阴性或Ⅰ度阳性.术后Lysholm评分高于术前,术后优42例,良5例,中3例.术后IKDC评分高于术前,术后IKDC评分A级41例,B级9例.结论：可吸收螺钉是治疗膝关节后交叉韧带胫骨止点撕脱骨折安全有效的方法,可使患者免除二次手术,而采取后正中后小切口创伤小,能够缩短手术时间和减少血管神经损伤.用可吸收拉力螺钉治疗后交叉韧带胫骨止点撕脱骨折需要严格掌握手术适应证.

Objective：To investigate method of absorbable screw fixation for the treatment of tibial avuls ion fracture of the tibial attachment of the posterior cruciate ligament through posterior middle miniinc ision of knee joint,and evaluate its clinical results.Methods：From January 2007 to December 2011,50 patients with tibial avulsion fracture of the tibial attachment of the posterior cruciate ligament were treated with absorbable screw fixation through posterior middle mini incision.Among the patients,38 patients w ere male and 12 patients were female,ranging in age from 18 to 62 years old,with an average of 36.8 years old.The duration of the disease ranged from 1 to 52 weeks.During the opeation,the blood vessels and nerves should be protected.Clinical results were evaluated according to the physical examination,Lysholm and IKDC clinical rating scales.Results：There were no nails broken in surgery,no postoperative complications such as infection,sinus formation and fracture fragment displacement.One patient had delay healing of inci sion.All the patients were followed up,and the duration ranged from 6 to 42 months,with an average of 30 mo nths.All the patients got bony union at the latest follow-up.Two patients had functional limitation of knee joint due to delayed review.At the latest follow-up,Lachman test and posterior drawer test were either negative or limited in gradeⅠof laxity.The range of motion of 50 patients improved from preoperative （94.5±6.2）°（90° to 110°） to postoperative （135.5±4.0）°（130° to 140°）.Lysholm score of all patients improved from preoperative 37.0±10.0（25 to 56） to 87.0±4.8（81 to 98） at the latest follow-up.Additionally,IKDC sc ores increased from preoperative 40.3±9.6（27 to 61） to 85.1±2.6 （82 to 96） at the latest follow-up.There were statistical differences in the Lysholm and IKDC scores comparing preoperative data with that at the latest follow-up.Based on Lysholm score,42 patients got an excellent result,5 good and 3 poor;according to IKDC score,41 patients got A degree and 9 patients got B degree.Conclusion：Absorbable screw fixation is a safe and effective method for the treatment of tibial avulsion fracture of the tibial attachment of the posterior cruciate ligament.A middle posterior approach with a mini incision can short operative time and reduce the chance of injuries of blood vessels and nerves.Absorbable screw fixation has a satisfactory clinical efficacy with strictly control of surgical indications.