关节镜与切开手术治疗后交叉韧带胫骨止点骨折的疗效比较

Arthroscopic versus open reduction and internal fixation for tibial avulsion fracture of posterior cruciate ligament

[目的]比较关节镜下复位固定与切开复位内固定治疗后交叉韧带胫骨止点撕脱性骨折的临床疗效。[方法]2014年3月～2018年3月本院收治急性后交叉韧带胫骨止点撕脱性骨折患者41例,随机分为两组,21例采用关节镜下克氏针缝线张力带固定(关节镜组),20例采用膝关节后内侧切口空心螺钉固定(切开复位组),比较两组的手术时间、切口长度、术后下地时间、住院时间、骨折解剖复位比例、骨折愈合时间、末次随访Lysholm评分及术后并发症等情况。[结果]两组患者均顺利手术,均无切口相关并发症。关节镜组手术时间(84.29±5.98) min明显长于切开复位组(59.75±7.86) min,切口长度(4.19±0.40) cm明显小于切开复位组(6.80±0.52) cm,术后下地时间(2.14±0.65) d明显早于切开复位组(3.80±1.64) d,住院时间(10.81±2.62) d明显小于切开复位组(13.70±4.60) d,差异均具有统计学意义(P<0.05)。关节镜组21例中16例获得解剖复位,切开复位组20例均获得解剖复位,差异具有统计学意义(P<0.05)。两组骨折愈合时间、末次随访Lysholm评分比较差异无统计学意义(P>0.05)。[结论]关节镜下克氏针缝线张力带固定和切开复位空心钉固定治疗后交叉韧带胫骨止点撕脱性骨折均可获得良好的手术效果。关节镜手术切口更短,术后下地时间更早,住院时间更短,但手术操作难度大,手术时间长且复位更加困难。

[Objective] To compare the clinical outcomes of arthroscopic versus open reduction and internal fixation for tibial avulsion fracture of posterior cruciate ligament(PCL). [Methods] From March 2014 to March 2018, a total of 41 patients with acute tibial avulsion fracture of PCL were randomly divided into two groups. Of them, 21 patients received arthroscopic reduction and internal fixation(ARIF), while the remaining 20 patients underwent open reduction and internal fixation(ORIF).The operation time, incision length, postoperative out-of-bed time, hospitalization time, complications, ratio of anatomic reduction of fracture, fracture healing time and Lysholm score were compared between the two groups. [Results] All the patients in both group had operation performed smoothly without serious complication. The ARIF group consumed significantly longer operation time than the ORIF group [(84.29±5.98) min versus(59.75±7.86) min, P<0.05], although the former took significantly shorter incision [(4.19±0.40) cm versus(6.80±0.52) cm, P<0.05], postoperative out-of-bed time [(2.14±0.65) d versus(3.80±1.64) d, P<0.05] and hospitalization time [(10.81±2.62) d versus(13.70±4.60) d, P<0.05] than the latter. Anatomic reduction was achieved in(16/21) patients of the ARIF group, while(20/20) patients of the ORIF group, which proved statistically significant(P<0.05). However, there were no statistically significant differences between the two groups regarding to the fracture healing time and Lysholm scores at the latest follow up(P>0.05). [Conclusion] Both ARIF and ORIF achieve satisfactory clinical outcomes for tibial avulsion fracture of PCL. Despite of taking shorter incision, postoperative out-of-bed time and hospitalization time, the ARIF consumes longer operation time associated with more complicated surgical operation, and more difficulty in fracture reduction.