关节镜下平衡点固定技术治疗前交叉韧带止点撕脱骨折的效果评价

Evaluation of arthroscopic balance point fixation in the treatment of avulsion fracture of anterior cruciate ligament

目的评价平衡点固定技术在关节镜下前交叉韧带止点撕脱骨折固定手术中的具体应用及效果。方法回顾性分析攀枝花市中心医院骨科2012年6月—2018年6月共65例采用关节镜下手术治疗前交叉韧带止点撕脱骨折的患者资料,按照是否采用平衡点固定技术将患者分为常规手术组(A组,n=22)和平衡点固定组(B组,n=43)。对两组手术时间、视觉模拟评分法(Visual Analogue Scale,VAS)疼痛评分、住院时间、术中再骨折率、肢体肿胀发生率、深静脉血栓形成发生率、Lysholm评分、膝关节稳定性等指标进行分析。计数资料采用χ2检验或Fisher确切概率法,计量资料采用独立样本t检验或配对t检验,等级资料采用秩和检验,重复测量资料采用重复测量方差分析;双侧检验水准α=0.05。结果两组患者年龄及性别构成、骨折类型、合并损伤、伤后到手术时间、术前VAS评分、Lysholm评分差异无统计学意义(P>0.05)。所有患者手术切口均Ⅰ期愈合,无切口并发症出现。A组骨折经调整后复位基本满意,4例(18.2%)发生再骨折;B组1例(2.3%)因骨质条件差出现再骨折,B组术中再骨折率低于A组(P=0.041)。B组手术时间及住院时间短于A组[(90.27±34.27)vs.(49.67±10.44)min,P<0.001;(8.09±1.23)vs.(5.35±1.07)d,P<0.001],术后VAS评分低于A组[(4.23±0.87)vs.(2.60±0.62)分,P<0.001],疼痛缓解程度优于A组[(3.32±1.29)vs.(4.44±1.50)分,P=0.004],术后肢体肿胀发生率低于A组(22.7%vs.4.7%,P<0.05);两组术后深静脉血形成发生率差异无统计学意义(P>0.05)。所有患者术后随访时间均超过1年,骨折均完全愈合,术后VAS及术后1年Lysholm评分较术前均有明显改善;两组术后6个月Lysholm评分、稳定性评估及术后1年Lysholm评分差异无统计学意义(P>0.05)。结论平衡点固定技术通过实现最佳固定点的量化减少重复操作及副损伤,对缓解术后疼痛、缩短手术时间及平均住院时间、降低并发症发生率有积极作用,疗效可靠,可以为临床工作提供技术参考。

Objective To evaluate the specific application and effect of balance point fixation technique in arthroscopic fixation of avulsion fracture of anterior cruciate ligament.Methods The data of 65 patients with anterior cruciate ligament avulsion fracture treated by arthroscopy in Department of Orthopaedics,Panzhihua Central Hospital between June 2012 and June 2018 were analyzed retrospectively.According to whether the balance point fixation technique was used or not,the patients were divided into routine operation group(group A,n=22)and balance point fixation group(group B,n=43).The operation time,Visual Analogue Scale(VAS)pain score,length of hospital stay,intraoperative bone re-fracture rate,incidences of limb swelling and deep venous thrombosis,Lysholm score and knee joint stability of the two groups were analyzed.Chi-square test or Fisher’s exact test was used for nominal data.Independent samples t-test or paired samples t-test was used for measurement data.Rank sum test was used for ordinal data.Repeated measures analysis of variance was used for repeated measurement data.Two-sided statistical significance level was set atα=0.05.Results There was no statistically significant difference in age,sex composition,fracture type,combined injury,time from injury to operation,preoperative VAS score,or Lysholm score between the two groups(P>0.05).The incisions of all patients healed in the first stage without incision complications.After adjustment,the reduction of fracture in group A was basically satisfactory,4 cases(18.2%)had re-fracture;1 case(2.3%)in group B had re-fracture due to poor bone condition,and group B was better than group A in re-fracture incidence(P=0.041).The operation time and length of hospital stay in group B were shorter than those in group A[(90.27±34.27)vs.(49.67±10.44)min,P<0.001;(8.09±1.23)vs.(5.35±1.07)d,P<0.001],the postoperative VAS score in group B was lower than that in group A(4.23±0.87 vs.2.60±0.62,P<0.001),the degree of pain relief in group B was better than that in group A(3.32±1.29 vs.4.44±1.50,P=0.004),the incidence of postoperative limb swelling in group B was lower than that in group A(22.7%vs.4.7%,P<0.05);the difference in incidence of postoperative deep venous thrombosis between the two groups was not statistically significant(P>0.05).All patients were followed up for more than one year,the fractures healed completely,and the postoperative VAS score and Lysholm score at one year after operation were significantly improved compared with those before operation,but there was no significant difference in the postoperative 6-month Lysholm score,stability evaluation,or postoperative 1-year Lysholm score between the two groups(P>0.05).Conclusions The balance point fixation technique plays a positive role in relieving postoperative pain,shortening operation time and average hospital stay,and reducing the incidence of complications by realizing the quantification of the best fixed point to reduce repeated operation and side injury.It can provide a technical reference for clinical work.