腘窝横形小切口建立直视通道治疗后交叉韧带胫骨止点撕脱骨折23例

Treatment of avulsion fracture of posterior cruciate ligament at tibial plateau with small transverse popliteal fossa incision:a report of 23 cases

目的 观察通过腘窝横形小切口建立直视通道治疗后交叉韧带(posterior cruciate ligaments,PCL)胫骨止点撕脱骨折的近期临床疗效。方法 回顾分析2018年3月至2021年6月本院采用腘窝横形小切口建立直视通道治疗PCL胫骨止点撕脱骨折的23例患者的临床及随访资料,观察手术时间及出血量,术后切口情况及骨折复位和愈合情况,比较手术前后膝关节屈伸活动度,并通过Lysholm评分评价膝关节功能。结果 23例患者获得平均13.2个月随访。本组患者手术时间25~50 min,平均32 min;术中平均出血量7.8 ml。所有切口均正常愈合,无并发症。本组术后1~3天、3个月、6个月膝关节正侧位X线片检查,骨折均复位良好,无复位丢失,骨折线术后3个月时模糊,6个月时基本消失。术后6个月膝关节屈伸活动度为(122.7±8.2)°,较术前(71.9±16.1)°明显改善;术后6个月Lysholm评分为(91.3±7.4)分,较术前(51.2±12.6)分明显改善,差异均有统计学意义(P <0.05)。结论 腘窝横形小切口建立直视通道治疗PCL胫骨止点撕脱骨折具有显露快速、手术时间短、出血少、对腘窝组织及血管神经扰动小、并发症少等优点,患者恢复快,功能良好,近期临床疗效满意。

Objective To observe the short-term clinical effect in the treatment of avulsion fracture of posterior cruciate ligament(PCL)at tibial plateau through a small transverse popliteal incision.Methods The clinical and follow-up data of 23 patients with avulsion fracture of PCL at tibial plateau,treated by popliteal transverse small incision in our hospital from March 2018 to June 2021,were retrospectively analyzed.The operation time,bleeding volume,incision condition after operation,fracture reduction and healing were observed.The knee joint flexion and extension before and after operation were compared,and the knee joint function was evaluated by Lysholm score.Results All 23 patients were followed up for an average of 13.2 months.The operation time of this group was 25-50 minutes,with an average of 32 minutes.The average intraoperative bleeding volume was 7.8 ml.All incisions healed normally without complications.In this group,X-ray examinations 1-3 days after operation,3 and 6 months after operation showed that the fractures were well restored without loss of reduction.The fracture line was blurred at 3 months,and basically disappeared at 6 months.The flexion and extension of the knee joint after operation was significantly improved compared with that before operation.Lysholm score was significantly improved 6 months after operation.Conclusions The treatment of avulsion fracture of PCL at tibial plateau with small transverse popliteal fossa incision and direct vision channel has the advantages of rapid exposure,short operation time,less bleeding,less disturbance to popliteal fossa tissue,blood vessels and nerves,fewer complications,rapid recovery,good function,and satisfactory short-term clinical effect.