后路内窥镜通道辅助下后交叉韧带胫骨止点撕脱骨折内固定

Posterior endoscopic channel assisted cannulated screw fixation for posterior cruciate ligament tibial eminence avulsion fractures

[目的]探讨后路内窥镜通道辅助下后空心钉固定治疗后交叉韧带胫骨止点撕脱骨折的疗效。[方法]2012年6月～2016年11月,收治37例后交叉韧带胫骨止点撕脱骨折患者。其中男25例,女12例;年龄22～54岁,平均(33.70±10.00)岁。受伤至手术时间(3～23)d,平均(7.30±3.82)d。按Meyers-McKeever分型:II型11例,III型26例。Lysholm评分33～79分,平均(52.13±4.22)分。国际膝关节文件编制委员会(IKDC)评分37～46分,平均(44.82±2.44)分。所有患者均采用后路内窥镜通道辅助下后交叉韧带胫骨止点空心钉内固定。[结果]所有患者均成功手术,手术时间30～65 min,平均(37.10±5.50)min;术中出血量10～75 ml,平均(23.70±6.10)ml;所有患者均未出现腘窝血管神经损伤症状。术后1例出现腘窝血肿,其余患者切口均I期愈合,无关节感染、皮肤坏死、腘窝瘢痕挛缩等并发症。患者均获得随访,平均随访时间(22.40±9.21)个月(12～50个月)。术后平均(8.10±2.10)周(7～9周)骨折达到临床愈合。术后12周患侧膝关节Lachman试验均为阴性。末次随访时Lysholm评分为89～96分,平均(94.19±0.93)分,IKDC评分为90～97分,平均(94.35±1.22)分,均较术前显著提高,差异有统计学意义(P<0.05)。[结论]后路内窥镜通道辅助下空心钉固定治疗后交叉韧带胫骨止点撕脱骨折疗效确切,具有微创、操作简单、安全的优点。

[Objective] To explore the clinical outcomes of posterior endoscopic channel assisted eannulated screw fixation for posterior erueiate ligament （PCL） tibial eminence avulsion fractures. [Methods] Between June 2012 and November 2016, 37 patients were surgically treated in our hospital for PCL tibial eminence avulsion fractures, including 25 males and 12 females aged from 22 to 54 years with a mean of 33.70 years. The time from injury to operation ranged from 3 to 23 days with average of 7.30 days. In term of Meyers-McKeever classification, 12 patients were of type Ⅱ and 26 of type Ⅲ. The Lyshohn score proved （52.13±4.22）, while the International Knee Documentation Committee （IKDC） score was （44.82±2.44） before operation. Assisted with posterior endoscopic channel, all PCL tibial eminence avulsion fractures were reduced and fixed with eannulated screws. [Results] All the patients had operation performed successfully with operation time of （37.10±5.50） min ranged from 30 to 65rain, intraoperative blood loss of （23.70±6.10） ml ranged froml0 to75ml, and without serious intraoperative complication such as neurovascular injuries in any of them. All the patients got primary healing of the incisions except 1 patient who had popliteal hematoma. No infection, skin necrosis and popliteal contracture occurred in anyone of them after operation. The patients were followed up for 12 to 50 months with an average time of （22.40±9.21） months. The entirety of fractures became clinically healed in 8.10 weeks ranged from 7 to 9 weeks. Every one of patients showed negative Laehman test at 12 weeks ＇after operation. The Lysholm score significantly increased to （94.19±0.93）, while the IKDC score to （94.35±1.22） at the latest follow-up, showing statistical differences compared with those preoperatively （P〈0.05）. [Conclusion] The posterior endoscopic channel assisted cannulated screw fixation for PCL tibial eminence avulsion fractures does achieve satisfactory clinical outcomes with advantages of minimized invasion, simplified surgical operation and improved safety.