镜下“8”字法缝线固定后交叉韧带胫骨撕脱骨折

Arthroscopic fixation of posterior cruciate ligament tibial avulsion fracture with figure "8" suture technique

[目的]介绍关节镜下“4”字位三入路“8”字缝线固定治疗后交叉韧带(posterior cruciate ligament,PCL)胫骨止点撕脱骨折的手术技术与初步效果。[方法]2019年3月-2021年3月,采用“4”字位三入路“8”字法缝线固定PCL胫骨撕脱性骨折28例。常规建立前外、前内和后内3个人口。从前内侧人口将2根强生Orthocord缝线经PCL前侧绕过后,从后内侧入口将缝线拉出并打结,防止骨块松脱。然后,将缝线两端交叉后,分别导入两个骨道,由胫骨前拉出。再次将PCL胫骨隧道定位器钩端置于骨块上,用其将骨块向后推压,进行临时复位固定。调整固定缝线使其从骨块后上方跨过,对膝施加前抽屉应力,复位固定骨块,同时拉紧缝线两端,使缝线牢固嵌压固定骨折块,将缝线尾端在骨道外口固定到门形钉或Versalok上完成固定。[结果]28例患者均顺利完成手术,无血管、神经损伤等严重并发症。Lysholm评分由术前(33.14±9.60)分显著增加至末次随访时(84.07±5.43)分(P<0.05);IKDC评分由术前(32.39±84.79)分显著增加至末次随访时(84.79±4.42)分(P<0.05)。末次随访时,临床检查显示,28例患者均无膝关节松弛或不稳定,膝活动度与健侧对称。影像方面,28例骨折均达临床骨愈合,无骨折移位。[结论]本技术具有简便易行、固定牢靠的优点,临床疗效满意。

[Objective]To introduce the surgical techniques and preliminary results of arthroscopic figure“8”suture in figure"4"position for posterior cruciate ligament(PCL)tibial avulsion fractures.[Methods]From March 2019 to March 2021,28 patients underwent abovementioned surgical treatment for PCL tibial avulsion fracture.Three portals were established:including anterolateral,anteromedial,and posteromedial portals.Sutures were introduced under the arthroscope and knotted around the PCL.Two bone tunnels were created on both sides of the fracture fragments,and then the sutures were introduced to the anterior aspect of the tibia through the bone tunnels.As the suture ends were pull out at anterior drawer position,the fracture was reduced firmly.Finally,the fractures were fastened by the sutures as them tied on anteriorly.[Results]All the 28 patients had operation performed successfully without serious complications,such as vascular and nerve injury.Lysholm score increased significantly from(33.14±9.60)before surgery to(84.07±5.43)at the latest follow-up(P<0.05),while IKDC score significandy increased from(32.39±84.79)preoperatively to(84.79±4.42)at the latest foUow-up(P<0.05).At the last follow-up,clinical examination showed that none of the 28 patients had knee joint relaxation or instability,with affected knee range of motion symmetrical with the healthy side.Radiographically,all the 28 fractures got fracture healing without displacement.[Conclusion]The technique is simple and reliable,does achieve satisfactory clinical outcomes for PCL tibial avulsion fractures.