关节镜下缝线“8”字捆扎固定治疗后交叉韧带胫骨止点撕脱骨折疗效探讨

Treatment of avulsion fracture of tibial insertion of posterior cruciate ligament with arthroscopic figure-of-8 suture fixation

目的探讨关节镜下缝线“8”字捆扎固定治疗后交叉韧带(PCL)胫骨止点撕脱骨折的疗效。方法收集该院2017-01~2018-12收治28例符合纳入标准的PCL胫骨止点撕脱骨折患者的临床资料,其中22例获得完整随访。记录手术时间、出血量、膝关节稳定性、Lysholm膝关节评分、膝关节活动度。结果22例患者术后获得12~20个月(平均14.8个月)随访。所有患者未出现切口感染、骨折不愈合或畸形愈合。末次随访时X线显示骨折均获得骨性愈合。末次随访时膝关节后抽屉试验阴性率(阴性21例,阳性Ⅰ度1例)较术前(均为阳性,Ⅰ度6例,Ⅱ度12例,Ⅲ度4例)明显提高(Z=6.026,P<0.001);末次随访时Lysholm膝关节评分为(87.27±4.88)分,较术前(35.45±5.52)分明显提高(t=32.235,P<0.001);末次随访时膝关节活动度为(123.55±3.93)°,较术前(44.64±6.26)°明显增大(t=48.951,P<0.001)。结论关节镜下缝线“8”字捆扎固定治疗PCL胫骨止点撕脱骨折具有手术切口小、创伤小、术后恢复快以及近期临床疗效满意的优点。

Objective To investigate the treatment effect of arthroscopic figure-of-8 suture fixation on avulsion fracture of tibial insertion of posterior cruciate ligament(PCL).Methods The clinical data of all the patients with avulsion fracture of tibial insertion of PCL admitted to our hospital from January 2017 to December 2018 were collected.Among the patients,28 cases met the inclusion criteria,and the complete follow-up was obtained in 22 cases.The operation time,the amount of bleeding,the knee stability,Lysholm knee score and the knee range of motion were recorded.Results Twenty-two patients were followed up for 12 to 20 months(an average of 14.8 months).None of the patients had incision infection,fracture nonunion or malunion.At the last follow-up,X-ray showed that all the fractures had bony union.Compared with that before operation(positive results in all the cases,degreeⅠin 6 cases,degreeⅡin 12 cases and degreeⅢin 4 cases),the negative rate of knee back drawer test was significantly elevated at the time of the last follow-up after operation(negative results in 21 cases,degreeⅠin 1 case)(Z=6.026,P<0.001).The Lysholm knee scores at the last follow-up[(87.27±4.88)points]were significantly higher than those before surgery[(35.45±5.52)points](t=32.235,P<0.001).The knee range of motion at the last follow-up[(123.55±3.93)°]was significantly greater than that before surgery[(44.64±6.26)°](t=48.951,P<0.001).Conclusion The treatment of avulsion fracture of tibial insertion of PCL with figure-of-8 suture fixation under arthroscope has the advantages of small incision,small trauma,rapid postoperative recovery and satisfactory short-term clinical effect.