关节镜下带袢钛板悬吊固定治疗后交叉韧带胫骨止点撕脱骨折

Arthroscopic suspension fixation with Endobutton in treatment of tibial insertion avulsion fractures of posterior cruciate ligament

目的探讨关节镜下带袢钛板悬吊固定治疗后交叉韧带(posterior cruciate ligament,PCL)胫骨止点撕脱骨折的疗效。方法回顾性分析2017年6月—2022年10月采用关节镜下带袢钛板悬吊固定治疗的52例(52膝)PCL胫骨止点撕脱骨折患者临床资料。男29例,女23例;年龄19~66岁,平均40.6岁。致伤原因:交通事故伤24例,运动伤17例,摔伤11例。受伤至手术时间6~19 d,平均13.3 d。Meyers-McKeever分型:Ⅱ型30例,Ⅲ型22例。患者后抽屉试验均为阳性。术前膝关节功能Lysholm评分为(21.3±6.7)分,国际膝关节文献委员会(IKDC)评分为(20.7±5.8)分,疼痛视觉模拟评分(VAS)为(5.3±0.7)分;膝关节活动度(41.73±3.17)°。基于术前CT三维重建图像测量,骨块长径13~25 mm,平均18.1 mm。记录手术时间及并发症发生情况,影像学复查骨折愈合情况,采用膝关节活动度、Lysholm评分、IKDC评分、VAS评分评价膝关节功能及疼痛情况。结果手术时间46~81 min,平均56.2 min。患者均获随访,随访时间12~28个月,平均20.1个月。术中发生撕脱骨块医源性骨折4例;术后发生膝关节积液2例,膝前痛1例。切口均Ⅰ期愈合。术后3个月影像学复查示骨折均达骨性愈合,无内固定失效发生。术后12个月患者膝关节功能良好,均恢复正常活动。末次随访时,膝关节活动度达(133.44±4.17)°、Lysholm评分(93.6±3.1)分、IKDC评分(93.4±2.5)分、VAS评分(1.0±0.6)分,与术前比较差异均有统计学意义(P<0.05)。结论关节镜下带袢钛板悬吊固定治疗PCL胫骨止点撕脱骨折操作简便,患者膝关节功能恢复良好。

Objective To investigate the effectiveness of arthroscopic suspension fixation with Endobutton in the treatment of tibial insertion avulsion fractures of posterior cruciate ligament(PCL).Methods A retrospective analysis was conducted on the clinical data of 52 patients(52 knees)with tibial insertion avulsion fractures of PCL,who were treated by arthroscopic suspension fixation with Endobutton between June 2017 and October 2022.There were 29 males and 23 females,with an average age of 40.6 years(range,19-66 years).There were 24 cases of traffic accident injuries,17 cases of sports injuries,and 11 cases of fall injuries.The time from injury to operation ranged from 6 to 19 days(mean,13.3 days).According to the Meyers-McKeever classification,there were 30 cases of typeⅡand 22 cases of typeⅢfractures.All patients exhibited positive posterior drawer test results.Preoperative knee joint function was assessed with Lysholm score(21.3±6.7),International Knee Documentation Committee(IKDC)score(20.7±5.8),and visual analogue scale(VAS)score(5.3±0.7);and knee joint range of motion was(41.73±3.17)°.Based on preoperative CT threedimensional reconstruction measurements,the longitudinal diameter of the avulsed bone fragment ranged from 13 to 25 mm(mean,18.1 mm).Operation time and occurrence of complications were recorded,and postoperative imaging was used to assess fracture healing.Knee joint function and pain severity were evaluated using knee joint range of motion,Lysholm score,IKDC score,and VAS score.Results The operation time ranged from 46 to 81 minutes(mean,56.2 minutes).All patients were followed up 12-28 months(mean,20.1 months).The iatrogenic fractures of bone fragments occurred during operation in 4 cases;and knee effusion occurred in 2 cases and anterior knee pain in 1 case after operation.All incisions healed by first intention.Imaging evaluations at 3 months after operation showed the fracture healing and no internal fixation failure.All patients demonstrated good knee function and had returned to normal activities at 12 months after operation.At last follow-up,the knee joint range of motion was(133.44±4.17)°,Lysholm score 93.6±3.1,IKDC score 93.4±2.5,and VAS score 1.0±0.6,with significant differences compared to preoperative scores(P<0.05).Conclusion Arthroscopic suspension fixation with Endobutton in the treatment of tibial insertion avulsion fractures of PCL is simple to operate,and the knee joint function recovers well.