关节镜下单隧道缝线套捆固定术治疗成人后交叉韧带胫骨止点骨折

Effectiveness of arthroscopic binding fixation using suture through single bone tunnel for posterior cruciate ligament tibial insertion fracture in adults

目的探讨关节镜下单隧道缝线套捆固定术治疗成人后交叉韧带(posterior cruciate ligament,PCL)胫骨止点骨折的疗效。方法2019年10月—2021年10月,采用关节镜下单隧道缝线套捆固定术治疗16例PCL胫骨止点骨折患者。男11例,女5例;年龄26~58岁,平均41.1岁。致伤原因:交通事故伤12例,运动伤4例。受伤至手术时间2~10 d,平均6.0 d。骨折分型:Meyers-McKeeverⅡ型4例、Ⅲ型9例,ZaricznyiⅣ型3例。后抽屉试验Ⅰ度2例、Ⅱ度7例、Ⅲ度7例。合并外侧副韧带损伤3例,半月板损伤2例。手术前后采用疼痛视觉模拟评分(VAS)、Lysholm评分、国际膝关节文献委员会(IKDC)评分及膝关节活动度评价膝关节功能,采用后抽屉试验以及膝关节稳定度测试仪Kneelax 3检查评价膝关节稳定性,X线片复查评价骨折复位愈合情况。结果术后切口均Ⅰ期愈合,无切口感染、腘窝神经血管损伤、下肢深静脉血栓形成等并发症发生。患者均获随访,随访时间6~12个月,平均10个月。术后6个月,X线片复查示骨折均达骨性愈合;后抽屉试验0度11例、Ⅰ度4例、Ⅱ度1例,与术前比较差异有统计学意义(Z=23.167,P<0.001);VAS评分、Lysholm评分、IKDC评分、膝关节活动度及Kneelax3检查均较术前改善,差异有统计学意义(P<0.05)。结论关节镜下单隧道缝线套捆固定术治疗成人PCL胫骨止点骨折具有创伤小、骨折复位佳且固定牢靠、并发症少等优点,患者膝关节功能恢复良好。

Objective To explore the effectiveness of arthroscopic binding fixation using suture through single bone tunnel for posterior cruciate ligament(PCL)tibial insertion fractures in adults.Methods Between October 2019and October 2021,16 patients with PCL tibial insertion fractures were treated with arthroscopic binding fixation using suture through single bone tunnel.There were 11 males and 5 females with an average age of 41.1 years(range,26-58years).The fractures were caused by traffic accident in 12 cases and sports in 4 cases.The time from injury to operation ranged from 2 to 10 days with an average of 6.0 days.The fractures were classified as Meyers-McKeever typeⅡin 4 cases and typeⅢin 9 cases,and Zaricznyi typeⅣin 3 cases.There were 2 cases of gradeⅠ,7 cases of gradeⅡ,and 7 cases of gradeⅢin the posterior drawer test.There were 3 cases combined with lateral collateral ligament injury and 2 cases with meniscus injury.The visual analogue scale(VAS)score,Lysholm score,International Knee Documentation Committee(IKDC)score,and knee range of motion were used to evaluate knee joint function.The posterior drawer test and knee stability tester(Kneelax 3)were used to evaluate knee joint stability.The X-ray films were used to evaluate fracture reduction and healing.Results All incisions healed by first intention after operation.There was no incision infection,popliteal neurovascular injury,or deep venous thrombosis of lower limbs.All patients were followed up 6-12 months,with an average of 10 months.X-ray films at 6 months after operation showed the fractures obtained bone union.There were11 cases of grade 0,4 cases of gradeⅠ,and 1 case of gradeⅡin posterior drawer test,showing significant difference when compared with preoperative results(Z=23.167,P<0.001).The VAS score,Lysholm score,IKDC score,knee range of motion,and the results of Kneelax3 examination all significantly improved when compared with preoperative results(P<0.05).Conclusion For adult patients with PCL tibial insertion fractures,the arthroscopic binding fixation using suture through single bone tunnel has the advantages of minimal trauma,good fracture reduction,reliable fixation,and fewer complications.The patient's knee joint function recovers well.