改良膝关节后侧微创切口对治疗后交叉韧带止点撕脱骨折的临床疗效

Clinical efficacy of modified posterior minimally invasive incision for posterior cruciate ligament avulsion fractures at tibial insertion

目的比较改良膝关节后侧微创切口与传统后内侧倒“L”形切口内固定对治疗膝关节后交叉韧带(PCL)胫骨止点撕脱骨折临床疗效。方法2020年6月至2023年6月北京积水潭医院贵州医院收治的36例PCL胫骨止点撕脱骨折患者;其中17例行改良膝关节后侧微创切口内固定治疗(改良组),19例行传统后内侧L形切口内固定治疗(传统组)。统计比较两组手术时间、术中出血量、切口长度、住院时间和膝关节活动度、膝关节功能Lysholm评分、国际膝关节文献委员会(IKDC)评分的情况。结果36例患者均获得随访,平均随访时间11.8(6~22)个月。两组手术时间、术中出血量、切口长度、住院时间比较差异有统计学意义(P<0.05)。末次随访改良组膝关节活动度为(121.7°±6.4°),膝关节功能Lysholm评分为(89.0±4.9)分,膝关节IKDC评分(91.8±4.0)分;传统组膝关节ROM为(110.2°±11.3°),膝关节功能Lysholm评分为(85.6±3.7)分,膝关节IKDC评分(86.7±2.2)分;两组差异有统计学意义(P<0.05)。改良组未发现膝关节僵硬病例,传统组发生膝关节僵硬1例(5.3%)。所有患者未发生其他并发症。结论改良膝关节后侧微创切口是一种微创、安全、有效的手术入路,具有手术时间更短,出血少,骨折端显露充分,康复快速等优势。

Objective To compare the clinical efficacy of modified posterior minimally invasive incision with traditional posteromedial inverted“L”incision for internal fixation in the treatment of posterior cruciate ligament(PCL)tibial insertion avulsion fractures.Methods A retrospective analysis was conducted on 36 patients with PCL tibial insertion avulsion fractures treated in Department of Orthopaedics,Guizhou Hospital of Beijing Jishuitan Hospital from June 2020 to June 2023.Among them,17 patients underwent internal fixation with a modified posterior minimally invasive incision(modified group),and 19 patients underwent internal fixation with a traditional posteromedial inverted“L”incision(traditional group).The terms of operation time,intraoperative blood loss,incision length,and hospital stay and knee joint range of motion(ROM),Lysholm knee function score,international knee documentation committee(IKDC)score were compared.Results All 36 patients were followed up,with an average follow-up duration of 11.8(6-22)months.Significant differences were observed between the two groups in terms of operation time,intraoperative blood loss,incision length,and hospital stay(P<0.05).At the final follow-up,the modified group had a knee joint ROM of(121.7°±6.4°),Lysholm knee function score of(89.0±4.9),and IKDC score of(91.8±4.0).The traditional group had a knee joint ROM of(110.2°±11.3°),Lysholm knee function score of(85.6±3.7),and IKDC score of(86.7±2.2),with significant differences between the two groups(P<0.05).No cases of knee joint stiffness were found in the modified group,while one case(5.3%)of knee joint stiffness occurred in the traditional group.No other complications were observed in any patients.Conclusion The modified posterior minimally invasive incision is a minimally invasive,safe,and effective surgical approach that offers advantages such as shorter operation time,less bleeding,sufficient fracture site exposure,and faster recovery.