关节镜辅助下治疗后交叉韧带撕脱骨折合并半月板后角止点撕裂的临床疗效研究

ARTHROSCOPICALLY ASSISTED TREATMENT OF POSTERIOR CRUCIATE LIGAMENT AVULSION FRACTURE WITH MENISCUS POSTERIOR HORN TEAR

目的 探讨关节镜辅助下治疗后交叉韧带（posterior cruciate ligament,PCL）撕脱骨折合并半月板后角止点撕裂的方法及疗效。方法 2012年1月-2014年12月,在关节镜辅助下采用骨科高强度聚酯缝线,经内外侧半月板后角钻取骨隧道捆绑PCL撕脱骨折合并半月板后角止点撕裂治疗21例患者。其中男10例,女11例;年龄14~53岁,平均35.7岁。致伤原因：运动损伤11例,交通事故伤9例,日常生活损伤1例。术前行膝关节正侧位X线片、CT及MRI检查,确诊为PCL撕脱骨折,其中2例合并前交叉韧带撕脱骨折。后抽屉试验均为（＋）,其中14例无终末点,7例有软性终末点;所有患者均有胫骨后沉征。术前国际膝关节评分委员会（IKDC）评分及Lysholm评分分别为（46.5±5.5）分及（43.3±4.5）分。受伤至手术时间为6~22 d,平均10 d。结果 手术时间60~100 min,平均75 min。术后患者切口均Ⅰ期愈合,无切口感染等并发症发生。21例均获随访,随访时间12~46个月,平均27.4个月。2例后抽屉试验为（＋）,但有硬性终末点,余19例均为（—）;所有患者胫骨后沉征消失。末次随访时,X线片示骨折均愈合良好,无明显移位及翘起;所有患者均无膝关节绞索及弹响症状,无膝关节内外侧间隙压痛,Mcmurray征（—）。末次随访时IKDC评分及Lysholm评分分别为（92.0±2.5）分和（92.7±2.6）分,与术前比较差异有统计学意义（t=—39.903,P=0.000;t=—43.242,P=0.000）。20例膝关节活动度正常,达0~130°;1例术后8周出现膝关节屈曲受限,活动度0~80°,给予麻醉下闭合松解后膝关节活动度恢复至0~120°。结论 采用聚酯缝线联合空心螺钉关节镜辅助下治疗PCL撕脱骨折合并半月板后角止点撕裂,操作简便,固定牢固。

Objective To evaluate the effectiveness of arthroscopically assisted treatment of posterior cruciate ligament （PCL） tibial eminence avulsion fractures associated with meniscus posterior horn tear. Methods Between January 2012 and December 2014, 21 patients with PCL avulsion fracture and meniscus posterior horn tear were arthroscopicaUy treated with polyester suture and hollow screw fixation. There were 10 males （10 knees） and 11 females （11 knees）, aged 14-53 years （mean, 35.7 years）. The causes included sport injury in 11 cases, traffic accident injury in 9 cases, and daily life injury in 1 case. Based on the anteroposterior and lateral X-ray films, CT, and MRI, PCL acalsion fractures were diagnosed, and 2 cases had anterior cruciate ligament avulsion fractures. The results of posterior drawer test were positive in all patients, with no end point in 14 cases and with soft end point in 7 cases; all patients showed tibial sink. The preoperative International Knee Documentation Committee （IKDC） score and Lysholm score were 46.5±5.5 and 43.3±4.5 respectively. The time from injury to operation was 6-22 days （mean, 10 days）. Results The operation time was 60-100 minutes （mean, 75 minutes）. Primary healing of incision was obtained in all patients, without no complication of infection. The mean follow-up time was 27.4 months （range, 12-46 months）. The results of posterior drawer test were 20 patients （0-1300） except 1 patient having limited flexion （0-80°）, whose range of motion returned to 0-120° after release. Conclusion The arthroscopic fixation technique has satisfactory results for the reduction and fixation of PCL avulsion fracture associated with meniscus posterior horn tear because of easy operation, firm fixation, and economic price.