涉及前后交叉韧带胫骨止点骨折的治疗研究

Study on treatment of tibial avulsion fractures of posterior cruciate ligament combined with anterior cruciate ligament

目的探讨关节镜联合后路直视下一期空心钉固定治疗膝关节前、后交叉韧带止点撕脱骨折的临床疗效。方法回顾性分析2010年1月至2015年6月该院收治的25例前、后交叉韧带胫骨止点均骨折患者的临床资料。患者均首先平卧位下行关节镜探查是否存在合并伤,确定骨折块及交叉韧带损伤情况,前交叉韧带止点骨折直接在关节镜下复位,并予以空心拉力螺钉内固定;改俯卧位,直视下切开复位后交叉韧带胫骨止点骨折,并予以空心拉力螺钉固定。术后予以下肢可调节矫形支具制动4~6周。选择国际膝关节评分委员会(IKDC)评分进行膝关节功能主观评价,选择Lysholm评分进行膝关节功能客观评价,骨折愈合情况选择X线片或CT评价。结果 25例患者均获得随访,随访时间6~24个月,中位随访时间为15个月;术后骨折均一期愈合,骨愈合时间9~24周,中位骨愈合时间为12周。末次随访时IKDC评分:跛行(4.88±0.29)分,支撑(4.65±0.36)分,疼痛(4.78±0.49)分,肿胀(4.88±0.52)分,下蹲(4.85±0.35)分,均高于术前,差异均有统计学意义(P<0.05)。末次随访时患侧Lysholm膝关节功能评分为(93.4±2.8)分,优良率为96.0%,与健侧比较差异均无统计学意义(P>0.05)。结论关节镜辅助下应用空心拉力螺钉固定治疗前交叉韧带胫骨止点骨折及应用后内侧入路小切口切开复位空心拉力螺钉固定后交叉韧带胫骨止点骨折具有操作简便、固定可靠、近期疗效满意等优点。

Objective To explore the clinical efficacy of one-stage cannulated screw fixation in treatment of tibial avulsion fracture at the insertion of posterior cruciate ligament （PCL） under posterior direction version and in treatment of tibial avulsion fracture at the anterior cruciate ligament （ACL）under arthroscopy. Methods From January 2010 to June 2015,25 patients with tib- ial avulsion fractures of the posterior cruciate ligament combined with the anterior cruciate ligament in our hospital were retrospec- tively analyzed. Firstly, arthroscopic exploration was conducted in all patients in their horizontal position,aiming to observe whether combined injures existed or not and to confirm fracture fragments and the degree of tibial avulsion fractures of the cruciate liga- ments. All patients recieved arthroscopic fragment fixation by using cannulated screws, then, were treated with a minimally postero- medial incision in the prone position by cannulated screw fixation. All knee joints were protected by adjustable orthopedic brace for 4-6 weeks. The clinical knee joint function of patients were measured by using International Knee Documentation Committee （IK- DC） scoring scale and Lysholm scoring scale. The X-ray or CT image were used to evaluate healing process of the fractures. Results All patients were followed up for 6-24 months, the median follow-up time was 15 months. All fractures healed in one stage, time of fracture healing ranged from 9 to 24 weeks,and the median time was 12 weeks. The average IKDC scores at the finial follow-up were as follows ： claudieation （4.88 ± 0.29） points, support （ 4.65 ± 0.36 ） points, pain （ 4.78 ± 0.49 ） points, swelling （ 4.88 ± 0.52 ） points,squat （4.85±0.35）points,all were higher than those before operation, there were statistically significant differences when compared with those assessed before operation （P〈0.05）. The average Lysholm score at the finial follow-up was （93.4 ± 2.8） points,the rate of excellent and fine was 96.0% ,no statistically significant difference was found compared with that at the healthy side （P〉0.05）. Conclusion The one-stage cannulated screw fixation in treatment of tibial avulsion fracture at the insertion of PCL under posterior direction version and in treatment of tibial avulsion fractures at the ACL under arthroscopy is easy and convenient to operate, which has the advantages of reliable fixation and satisfactory recent curative efficacy.