3种手术入路治疗后交叉韧带胫骨止点撕脱骨折的疗效比较  

Comparison of curative effects of three kinds of surgical approaches for tibial avulsion fracture of posterior cruciate ligament

作　　者：邢宝瑞[1] 韩广普[1] 臧建成[1] 袁福禄[1] 陈超[1] 

机构地区：[1]河北省沧州中西医结合医院,河北沧州061001

出　　处：《中医正骨》2011年第9期9-11,13,共4页The Journal of Traditional Chinese Orthopedics and Traumatology

摘　　要：目的:比较常规腘部"S"形切口入路、腘窝后内侧小切口入路及关节镜下治疗后交叉韧带胫骨止点撕脱骨折的临床疗效。方法:2009年4月至2010年6月,我院收治的后交叉韧带胫骨止点撕脱骨折患者中病历资料完整者共98例,其中采用常规腘部"S"形切口入路者31例(Ⅰ组),关节镜下治疗者34例(Ⅱ组),腘窝后内侧小切口入路者33例(Ⅲ组)。记录并比较各组患者的手术时间、切口长度、术中出血量及血管神经损伤情况。所有患者均于术后6个月按照Lysholm膝关节评分标准进行疗效评定。95～100分为优,84～94分为良,<84分为可。结果:①术中指标。3组患者手术时间比较,差异有统计学意义(F=94.062,P=0.000);Ⅰ组患者比其他2组患者手术时间长(P=0.000;P=0.000);Ⅱ、Ⅲ组患者手术时间比较,差异无统计学意义(P=0.072)。3组患者切口长度比较,差异有统计学意义(F=831.283,P=0.000);Ⅰ组患者切口长度比其他2组患者长(P=0.000;P=0.000);Ⅱ、Ⅲ组患者切口长度比较,差异无统计学意义(P=0.803)。3组患者术中出血量比较,差异有统计学意义(F=77.814,P=0.000);Ⅰ组患者术中出血量比其他2组患者多(P=0.000;P=0.000),Ⅱ、Ⅲ组患者术中出血量比较,差异无统计学意义(P=0.263)。3组患者血管神经损伤情况比较,差异有统计学意义(P=0.003);组间两两比较,调整检验水准α=0.05/3=0.016,Ⅰ组发生血管神经损伤的患者比例比其他2组高(P=0.011;P=0.012),Ⅱ、Ⅲ组发生血管神经损伤的患者比例,差异无统计学意义(P=1.000)。②Ⅱ、Ⅲ组疗效优于Ⅰ组(Z=-2.598,P=0.009;Z=-2.503,P=0.012),Ⅱ、Ⅲ组疗效差异无统计学意义(Z=-0.101,P=0.920)。结论:在手术治疗后交叉韧带胫骨止点撕脱骨折时,腘窝后内侧小切口入路和关节镜下治疗比常规腘部"S"形切口入路具有明显的优势。Objective：To compare the curative effects of the 3 methods as conventional S-shaped incision into the popliteal parts,small incision into the posteromedial popliteal fossa and arthroscopic treatment for tibial avulsion fracture of posterior cruciate ligament（PCL）.Methods：Ninety-eight cases with complete medical records were selected from the patients with tibial avulsion fracture of PCL treated in our hospital from April 2009 to June 2010.Thirty-one cases in groupⅠwere administrated with conventional S-shaped incision into the popliteal parts,34 cases in groupⅡwere administrated with arthroscopic treatment,while the others in groupⅢwere administrated with small incision into the posteromedial popliteal fossa.The operation time,incision length,amount of blood loss and situations of the neurovascular injury of the patients were recorded and compared among the 3 groups.Six months after the operation,the curative effects of all the patients were evaluated according to Lysholm knee joint scoring standards.Scores ranged from 95 to 100 were considered as excellent,scores ranged from 84 to 94 were considered as good,while the scores less than 84 were considered as fair.Results：①Intraoperative index：There was statistical difference in the operation time,incision length and amount of blood loss among the 3 groups（F=94.062,P=0.000;F=831.283,P=0.000;F=77.814,P=0.000）;and the operation time of groupⅠwas longer than that of the other 2 groups（P=0.000;P=0.000）,so does the incision length and amount of blood loss;while there was no statistical difference between groupⅡand groupⅢin above indices（P=0.072;P=0.803;P=0.263）.There was statistical difference in the situations of the neurovascular injury among the 3 groups（P=0.003）.According to adjusted size of test（α=0.05/3=0.016）,the proportion of patients with neurovascular injury in groupⅠwas higher than that in the other 2 groups（P=0.011;P=0.012）,while there was no statistical difference between groupⅡand groupⅢ（P=1.000）.

关 键 词：后交叉韧带 膝关节 关节镜检查 治疗 临床研究性 

分 类 号：R687.3[医药卫生—骨科学]