关节镜纯前方入路与切开复位治疗Meyers McKeeverⅢ型后交叉韧带胫骨止点撕脱骨折的效果分析

Analysis of the Effect of Arthroscopic Surgery from Front Admission Passage and Open Reduction and Internal Fixation on Meyers McKeeverⅢTibial Avulsion Fracture of Posterior Cruciate Ligament

目的:比较两种方法治疗Meyers Mckeever分型为Ⅲ型的后交叉韧带胫骨止点撕脱骨折的临床效果。方法:回顾性分析2013年1月-2020年12月萍乡市第二人民医院收治的Meyers MckeeverⅢ型后交叉韧带胫骨止点撕脱骨折60例,依据治疗方法不同分成观察组(30例)及对照组(30例)。观察组采用关节镜纯前方入路治疗,对照组采用切开复位治疗。比较两组手术时间、切口大小、出院时间、视觉模拟评分法(VAS)评分、膝关节Lysholm评分、Tegner评分及骨折愈合情况。结果:观察组手术时间长于对照组,切口长度与住院时间均短于对照组,差异均有统计学意义(P<0.05)。观察组术后1、3、5 d及3个月的VAS评分均低于对照组,差异均有统计学意义(P<0.05)。观察组术后6周和3、6、12个月的Lysholm评分均高于对照组,观察组术后3、6、12个月的Tegner评分均高于对照组,差异均有统计学意义(P<0.05)。结论:关节镜纯前方入路治疗Meyers McKeeverⅢ型后交叉韧带胫骨止点撕脱骨折,手术安全、微创、疼痛轻、能处理关节内损伤,手术效果满意,临床应用优势明显。

Objective:To compare the clinical effects of two methods in the treatment of tibial avulsion fracture of posterior cruciate ligament classified as typeⅢby Meyers McKeever.Method:A total of 60 cases of tibial avulsion fracture of Meyers McKeeverⅢposterior cruciate ligament treated in Pingxiang Second People’s Hospital from January 2013 to December 2020 were retrospectively analyzed.According to different treatment methods,they were divided into observation group(30 cases)and control group(30 cases).The observation group was treated with arthroscopic pure anterior approach,and the control group was treated with open reduction.The operation time,incision size,discharge time,VAS score,Lysholm score of knee joint,Tegner score and fracture healing were compared between the two groups.Result:The operation time in the observation group was longer than that in the control group,and the incision length and hospital stay were shorter than those in the control group,the differences were statistically significant(P<0.05).The VAS scores in the observation group at 1,3,5 d and 3 months after operation were lower than those in the control group(P<0.05).The Lysholm scores of the observation group at 6 weeks and 3,6,12 months after operation were higher than those of the control group,and the Tegner scores at 3,6,12 months after operation were higher than those of the control group(P<0.05).Conclusion:Arthroscopic pure anterior approach in the treatment of Meyers McKeeverⅢposterior cruciate ligament tibial insertion avulsion fracture is safe,minimally invasive,light in pain,and can deal with intra-articular injuries.The surgical effect is satisfactory,and the advantages of clinical application are obvious.