后交叉韧带胫骨止点撕脱骨折应用缝线桥悬吊固定与切开复位内固定对膝关节损伤的疗效观察

Curative effect of suture bridge suspension fixation and open reduction internal fixation on posterior cruciate ligamenta tibial dearticulation fracture for knee injury

目的 分析后交叉韧带胫骨止点撕脱骨折应用缝线桥悬吊固定与切开复位内固定对膝关节损伤疗效的影响。方法 前瞻性选取2020年3月至2022年3月秦皇岛市第一医院收治的90例后交叉韧带胫骨止点撕脱骨折患者作为研究对象,按照信封法将患者分为观察组45例和对照组45例。观察组接受关节镜下缝线桥悬吊固定疗法,对照组接受切开复位内固定疗法。比较两组临床指标情况(手术时间、术后引流量、住院时间、骨折愈合时间),记录并比较两组术前及术后1、3、6个月的膝关节活动功能[关节活动度(ROM)、Lysholm膝关节功能评分、Tegner运动水平评分及国际膝关节文献委员会膝关节评估表(IKDC)评分]及术后并发症发生情况。结果 观察组手术时间、住院时间分别为(44.46±5.64) min、(6.98±2.16) d,均短于对照组[(67.26±6.89) min、(11.23±1.26) d],差异均有统计学意义(P<0.05),观察组和对照组患者的术后引流量及骨折愈合时间比较,差异均无统计学意义(P>0.05)。观察组与对照组在术前及术后1、3、6个月时的ROM比较,差异均无统计学意义(P>0.05);两组术后1、3、6个月的ROM均高于术前,差异均有统计学意义(P<0.05)。术后1、3、6个月,两组患者的Lysholm评分均较术前升高,且观察组术后1、3、6个月的Lysholm评分分别为(69.98±1.02)、(88.44±3.49)、(94.56±1.23)分,均高于对照组[(67.46±1.45)、(80.55±2.98)、(90.22±0.98)分],差异均有统计学意义(P<0.05)。术后1、3、6个月,两组患者的Tegner评分均较术前升高,且观察组术后1、3个月的Tegner评分分别为(2.33±0.51)、(4.05±0.31)分,均高于对照组[(2.11±0.45)、(3.55±0.45)分],差异均有统计学意义(P<0.05),但在术后6个月时组间Tegner评分比较,差异无统计学意义(P>0.05)。术后1、3、6个月,两组患者的IKDC评分均高于术前,且同时间点组间比较,观察组的IKDC评分分别为(57.32±2.98)、(86.46±3.19)、(94.21±1.65)分,均高于对照组[(53.27±2.08)、(82.01±2.01)、(90.01±1.02)分],差异均有统计学意义(P<0.05)。观察组随访期内并发症发生率为11.11%,低于对照组(28.89%),差异有统计学意义(P<0.05)。结论 后交叉韧带胫骨止点撕脱骨折患者应用缝线桥悬吊固定可以提高治疗效果,与切开复位内固定相比,术后膝关节功能恢复情况更好,能有效缩短手术时间和住院时间,具有较高的临床应用价值。

Objective To analyze the effect of suture bridge suspension fixation and open reduction internal fixation on the knee injury of posterior cruciate ligament tibial insertion fracture.Methods A total of 90 patients with tibial avulsion fracture of posterior cruciate ligament admitted to Qinhuangdao No.1 Hospital from March 2020 to March 2022 were prospectively selected as the research objects.According to the envelope method,the patients were divided into observation group(45 cases)and control group(45 cases).The observation group received arthroscopic suture bridge suspension fixation,and the control group received open reduction and internal fixation.The clinical indicators(operation time,postoperative drainage volume,hospitalization time,fracture healing time)were compared between the two groups,and knee joint functional activity[range of motion(ROM),Lysholm knee function score,Tegner activity level score,and International Knee Documentation Committee knee evaluation form(IKDC)score]were recorded before operation and at 1,3,and 6 months after operation,incidence of postoperative complications was compared between the two groups.Results The operation time and hospitalization time of the observation group were(44.46±5.64)min and(6.98±2.16)d,respectively,which were shorter than those of the control group[(67.26±6.89)min and(11.23±1.26)d],the differences were statistically significant(P<0.05).There were no statistically significant differences in postoperative drainage volume and fracture healing time between the observation group and the control group(P>0.05).There was no statistically significant difference in ROM between the observation group and the control group before operation,1,3 and 6 months after operation(P>0.05).The ROM of the two groups at 1,3 and 6 months after operation were higher than those before operation,and the differences were statistically significant(P<0.05).At 1,3 and 6 months after operation,the Lysholm scores of the two groups were higher than those before operation,and the Lysholm scores of the observation group at 1,3 and 6 months after operation were(69.98±1.02),(88.44±3.49)and(94.56±1.23)points,respectively,which were higher than those of the control group[(67.46±1.45),(80.55±2.98)and(90.22±0.98)points],the differences were statistically significant(P<0.05).At 1,3 and 6 months after operation,the Tegner scores of the two groups were higher than those before operation,and the Tegner scores of the observation group at 1 and 3 months after operation were(2.33±0.51)and(4.05±0.31)points,respectively,which were higher than those of the control group[(2.11±0.45)and(3.55±0.45)points],the differences were statistically significant(P<0.05).At 1,3 and 6 months after operation,the IKDC scores of the two groups were higher than those before operation,and the IKDC scores of the observation group were(57.32±2.98),(86.46±3.19)and(94.21±1.65)points,respectively,which were higher than those of the control group[(53.27±2.08),(82.01±2.01)and(90.01±1.02)points],the differences were statistically significant(P<0.05).The incidence of complications in the observation group during the follow-up period was 11.11%,which was lower than that in the control group(28.89%),and the difference was statistically significant(P<0.05).Conclusion Compared with open reduction and internal fixation,the application of suture bridge suspension fixation in patients with posterior cruciate ligament tibial dearticulation fracture can improve the therapeutic effect,the postoperative functional recovery of the knee joint is better,and the operation time and hospital stay can be effectively shortened,which has high clinical application value.