关节镜下与切开固定治疗后交叉韧带胫骨止点骨折的比较

Arthroscopic versus open reduction and internal fixation for tibial avulsion fracture of posterior cruciate ligament

[目的]探讨关节镜下ETHIBOND线与Inlay切开治疗膝关节后交叉韧带胫骨止点撕脱骨折的临床疗效。[方法] 2014年1月～2017年6月收治的40例急性后交叉韧带胫骨止点撕脱骨折患者,依据住院号单双数随机分为关节镜组18例,切开组22例。评估两组患者术前、术后3 d、术后1个月、末次随访时VAS评分,记录手术时间、膝关节活动度和后抽屉试验稳定性,并使用Lysholm及IKDC评分系统评价膝关节功能恢复情况。[结果]两组手术均顺利完成,无血管神经损伤等严重并发症。关节镜组手术时间显著长于切开组,差异有统计学意义(P<0.05)。平均随访(18.26±4.64)个月。术后影像学检查(X线片和CT)显示所有患者骨折均复位满意并一期愈合。关节镜组术后3d VAS评分高于切开组,差异有统计学意义(P<0.05),但术前、术后1个月VAS评分和末次随访时VAS评分两组差异无统计学意义(P<0.05)。末次随访时,两组患者的后抽屉试验阴性率、膝关节平均活动度、Lysholm评分、IKDC评分差异均无统计学意义(P>0.05)。[结论]关节镜下ETHIBOND线固定与Inlay切开锚钉固定治疗PCL胫骨止点撕脱骨折均可获得满意的临床疗效,但切开组在手术时间和早期术后疼痛方面更具优势。

[Objective]To analyze the clinical outcomes of reduction and internal fixation by arthroscopic Ethibond suture versus anchor suture through Inlay incision for posterior cruciate ligament(PCL)tibial avulsion fractures.[Methods]From January 2014 to June 2017,40 patients with acute displaced tibial avulsion fracture of PCL were surgically treated in our department.According to even and odd number of the hospital numbers,the patients were randomly divided into two groups,including18 patients who had fracture reduced and fixed with Ethibond suture under arthroscopy,and 22 patients who underwent open reduction and internal fixation with anchor sutures through the posterior approach for Inlay technique.The visual analogue scale(VAS)for pain was evaluated preoperatively,3 days,1 month postoperatively,and at the last follow-up.The operative time,posterior drawer test(PDT)and range of motion(ROM)were recorded.The functional recovery of knee joint was evaluated by Lysholm and IKDC scoring system.[Results]All patients had operation performed smoothly without serious complications,such as neurovascular injuries.The arthroscopic group spent significantly longer operation time than the open group(P<0.05).All of them were followed up for an average of(18.26±4.64)months.All patients got fracture healed well without displacement according to the X-ray and CT images.The arthroscopic group got significantly higher VAS score at 3 days postoperatively than the open group,although no statistically significant differences were proved between the two groups in VAS scores before operation,at 1 month postoperatively and the latest follow up(P>0.05).At the latest follow up,no statistically significant differences were found between the two groups regarding to negative rate of PDT,ROM,Lysholm and IKDC scores(P>0.05).[Conclusions]Both arthroscopic Ethibond suture fixations and anchor suture fixation through Inlay incision do achieve satisfactory clinical outcomes for posterior cruciate ligament(PCL)tibial avulsion fractures.By comparison,the open approach has advantages in terms of operation time and early pain relief postoperatively over the arthroscopic approach.