单隧道免打结锚钉治疗后交叉韧带胫骨止点撕脱骨折

doi:10.3877/cma.j.issn.1674-134X.2020.03.020

目的

总结关节镜下利用单隧道免打结锚钉治疗后交叉韧带(PCL)胫骨止点撕脱骨折的效果。

方法

回顾性分析2017年1月至2019年4月淮南朝阳医院骨科收治的PCL胫骨止点撕脱骨折患者，按照纳入排除标准，共纳入36名行关节镜单隧道免打结锚钉内固定治疗的患者。比较每例患者术前及术后6个月的膝关节活动度(ROM)、国际膝关节文献委员会(IKDC)膝关节韧带评估表、Lysholm膝关节功能评分及并发症情况，进行配对立样本t检验。

结果

术后6个月随访ROM范围(t＝－22.231)、IKDC评分(t＝－34.958)、Lysholm评分(t＝－40.802)均比术前明显改善(均为P<0.05)；所有患者均未出现腘窝神经、血管损伤。

结论

采用关节镜下单隧道免打结锚钉内固定技术治疗后交叉韧带胫骨止点撕脱骨折，膝关节功能恢复情况满意。

关键词: 后交叉韧带, 胫骨骨折, 关节镜检查

Objective

To examine the clinical outcomes of arthroscopic single-tunnel suture fixation for posterior cruciate ligament(PCL) tibial avulsion fractures.

Methods

A retrospective analysis was conducted with PCL tibial avulsion fractures treated with arthroscopic single-tunnel suture fixation in the Department of Orthopedics, Chaoyang Hospital in Huainan from January 2017 to April 2019 and 36 patients were included in this studyaccording to the inclusion and exclusion criteria. Comparing the range of motion (ROM), the International Knee Documentation Committee (IKDC) knee ligament assessment andthe Lysholm knee function score of knee joint before operation and 6 months after operation, paired sample t test was performed, .

Results

The ROM (t=-22.231), IKDC score (t=-34.958) and Lysholm score (t=-40.802) at six-month follow-up after the operation were significantly improved compared with those before operation, and the difference was statistically significant (all P<0.05). No popliteal neurovascular bundle injury occurred.

Conclusion

This arthroscopic single-tunnel suture fixation for PCL tibial avulsion fracture may yield good clinical outcomes and satisfactory stability, which can be a useful treatment option for PCL tibial avulsion fracture.

Key words: Posterior cruciate ligament, Tibial fractures, Arthroscopy

表1 术前与术后6个月膝关节功能比较[n＝36，(±s)]

?	ROM(°)	IKDC评分	Lysholm评分
术前	76±9	46±9	43±6
术后6个月	121±6	93±3	93±4
t值	－22.231	－34.958	－40.802
P值	<0.05	<0.05	<0.05

表1 术前与术后6个月膝关节功能比较[n＝36，(±s)]

?	ROM(°)	IKDC评分	Lysholm评分
术前	76±9	46±9	43±6
术后6个月	121±6	93±3	93±4
t值	－22.231	－34.958	－40.802
P值	<0.05	<0.05	<0.05

[1]	Logan M, Williams A, Lavelle J, et al. The effect of posterior cruciate ligament deficiency on knee kinematics[J]. Am J Sports Med，2004，32(8): 1915-1922.
[2]	Boynton MD, Tietjens BR. Long-term followup of the untreated isolated posterior cruciate ligament-deficient knee[J]. Am J Sports Med，1996，24(3): 306-310.
[3]	Huang W, Gong X, Rahul M, et al. Anterior arthroscopic-assisted fixation of posterior cruciate ligament avulsion fractures[J/OL]. Eur J Med Res，2015，20: 88.doi: 10.1186/s40001-015-0177-6.
[4]	Sabat D, Jain A, Kumar V. Displaced posterior cruciate ligament avulsion fractures: a retrospective comparative study between open posterior approach and arthroscopic single-tunnel suture fixation[J]. Arthroscopy，2016，32(1): 44-53.
[5]	Chen W, Luo W, Chen Z, et al. Treatment of posterior cruciate ligament avulsion fractures of the tibia using a toothed plate and hollow lag screw[J]. Singapore Med J，2016，57(1): 39-44.
[6]	Bali K, Prabhakar S, Saini U, et al. Open reduction and internal fixation of isolated PCL fossa avulsion fractures[J]. Knee Surg Sports Traumatol Arthrosc，2012，20(2): 315-321.
[7]	Chen W, Tang D, Kang L, et al. Effects of microendoscopy-assisted reduction and screw fixation through a single mini-incision on posterior cruciate ligament tibial avulsion fracture[J]. Arch Orthop Trauma Surg, 2012, 132(4): 429-435.
[8]	Jazayeri SM, Esmaili JA, Karami M. A safe postero-medial approach to posterior cruciate ligament avulsion fracture[J]. Knee Surg Sports Traumatol Arthrosc，2009, 17(3): 244-247.
[9]	Dhillon MS, Singh HP, Nagi ON. Posterior cruciate ligament avulsion from the tibia: fixation by a posteromedial approach[J]. Acta Orthop Belg，2003，69(2): 162-167.
[10]	Rhee SJ, Jang JH, Choi YY, et al. Arthroscopic reduction of posterior cruciate ligament tibial avulsion fracture using two cross-linked pull-out sutures: a surgical technique and case series[J]. Injury, 2019, 50(3): 804-810.
[11]	Yoon JR, Park CD, Lee DH. Arthroscopic suture bridge fixation technique with multiple crossover ties for posterior cruciate ligament tibial avulsion fracture[J]. Knee Surg Sports Traumatol Arthrosc，2018，26(3): 912-918.
[12]	王新民，赵海霞，王巍，等. 关节镜极后高位入路置钉治疗后交叉韧带胫骨止点撕脱骨折[J/CD]. 中华关节外科杂志(电子版)，2017, 11(6): 582-588.
[13]	Zhu W, Lu W, Cui J, et al. Treatment of tibia avulsion fracture of posterior cruciate ligament with high-strength suture fixation under arthroscopy[J]. Eur J Trauma Emerg Surg, 2017, 43(1): 137-143.
[14]	朱伟民，陆伟，欧阳侃，等. 关节镜下高强线固定治疗后交叉韧带下止点撕脱骨折[J/CD]. 中华关节外科杂志(电子版), 2013, 7(1): 40-43.
[15]	Zhao J, He Y, Wang J. Arthroscopic treatment of acute tibial avulsion fracture of the posterior cruciate ligament with suture fixation technique through Y-shaped bone tunnels[J]. Arthroscopy，2006，22(2): 172-181.
[16]	Kim SJ, Shin SJ, Cho SK, et al. Arthroscopic suture fixation for bony avulsion of the posterior cruciate ligament[J]. Arthroscopy，2001，17(7): 776-780.
[17]	Kim SJ, Shin SJ, Choi NH, et al. Arthroscopically assisted treatment of avulsion fractures of the posterior cruciate ligament from the tibia[J]. J Bone Joint Surg Am，2001，83(5): 698-708.
[18]	Gwinner C, Hoburg A, Wilde S, et al. All-arthroscopic treatment of tibial avulsion fractures of the posterior cruciate ligament[J/OL]. GMS Interdiscip Plast Reconstr Surg DGPW, 2016, 5: Doc2.doi: 10.3205/iprs000081.
[19]	Hooper PR, Silko C, Malcolm TL, et al. Management of posterior cruciate ligament tibial avulsion injuries: a systematic review[J]. Am J Sports Med，2018，46(3): 734-742.
[20]	Malempati C, Felder J, Elliott M, et al. Current arthroscopic concepts in repairing posterior cruciate ligament tibial-sided avulsions[J]. Orthopedics, 2015, 38(9): 563-569.
[21]	Camara-Arrigunaga F, Camposeco-Longo P, Nieves-Silva J, et al. Fixation with anchors for posterior cruciate ligament avulsion by arthroscopy: a new technique[J/OL]．Arthroscopy, 2005, 21(9): 1146.doi: 10.1016/j.arthro.2005.08.001.
[22]	Lubowitz JH, Elson WS, Guttmann D. Part II: Arthroscopic treatment of tibial plateau fractures: intercondylar eminence avulsion fractures[J]. Arthroscopy, 2005, 21(1): 86-92.

[1]	蔡雨琦, 史尉利, 陶立元, 曹建夫, 崔国庆, 杨渝平. 支持带松解联合外侧成形治疗髌骨外侧过度挤压综合征[J]. 中华关节外科杂志(电子版), 2024, 18(02): 186-192.
[2]	夏传龙, 迟健, 丛强, 连杰, 崔峻, 陈彦玲. 富血小板血浆联合关节镜治疗半月板损伤的临床疗效[J]. 中华关节外科杂志(电子版), 2023, 17(06): 877-881.
[3]	刘瀚忠, 黄生辉, 万俊明, 李家春, 舒涛. 髌上入路和髌旁外侧入路髓内钉治疗胫骨骨折疗效比较[J]. 中华关节外科杂志(电子版), 2023, 17(06): 795-801.
[4]	马鹏程, 刘伟, 张思平. 股骨髋臼撞击综合征关节镜手术中闭合关节囊的疗效影响[J]. 中华关节外科杂志(电子版), 2023, 17(05): 653-662.
[5]	夏效泳, 王立超, 朱治国, 丛云海, 史宗新. 深度塌陷性胫骨平台骨折的形态特点和治疗策略[J]. 中华关节外科杂志(电子版), 2023, 17(05): 625-632.
[6]	肖志满, 龚煜, 谢景凌, 刘斌伟. 上下肢关节镜手术后患者下肢深静脉血栓发生的对比研究[J]. 中华关节外科杂志(电子版), 2023, 17(05): 601-606.
[7]	吴俊贤, 曾俊杰, 许有银, 苑博. 体外冲击波疗法辅助治疗肩袖修补术后关节僵硬[J]. 中华关节外科杂志(电子版), 2023, 17(04): 571-576.
[8]	邢阳, 何爱珊, 康焱, 杨子波, 孟繁钢, 邬培慧. 前交叉韧带单束联合前外侧结构重建的Meta分析[J]. 中华关节外科杂志(电子版), 2023, 17(04): 508-519.
[9]	刘延子, 王维军, 韩向东, 田学东. 保留残余腱束与残端重建前交叉韧带后外侧束[J]. 中华关节外科杂志(电子版), 2023, 17(03): 439-442.
[10]	邬春虎, 马玉海, 陈长松, 尹华东, 朱晓峰, 何剑星, 刘彧. 冲击波联合富血小板血浆对骨关节炎软骨损伤的疗效[J]. 中华关节外科杂志(电子版), 2023, 17(03): 334-339.
[11]	曾俊杰, 张绍龙, 马栋, 李玉民, 苑博. 单排缝合与Mason-Allen缝合治疗中小型肩袖损伤疗效对比[J]. 中华关节外科杂志(电子版), 2023, 17(02): 165-172.
[12]	薛清佩. 玻璃酸钠注射对半月板撕裂患者疗效的影响[J]. 中华关节外科杂志(电子版), 2023, 17(02): 288-291.
[13]	吴萍, 刘永林, 陈能彬, 季明军, 万晓波. 应用皮瓣联合负压封闭引流及灌洗引流治疗胫骨骨折术后钢板外露的临床效果[J]. 中华损伤与修复杂志(电子版), 2023, 18(04): 317-320.
[14]	高岩, 张泽, 张进, 张登峰, 刘杰, 刘沛东, 包勤济, 张永红. 主辅钢板内固定治疗胫骨中下1/3骨折的初步临床研究[J]. 中华老年骨科与康复电子杂志, 2023, 09(01): 39-44.
[15]	薛喆, 裴征, 唐冲, 张昆, 张辉, 贾俊秀, 李冬, 薛涛, 刘家帮, 张清华, 王鲁宁, 关振鹏. 成人复发性髌骨脱位术前高度膝关节J形征导致术后内侧髌股韧带移植物残存松弛的分析[J]. 中华临床医师杂志(电子版), 2023, 17(02): 125-135.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Arthroscopic single-tunnel suture fixation for posterior cruciate ligament tibial avulsion fractures

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Arthroscopic single-tunnel suture fixation for posterior cruciate ligament tibial avulsion fractures