关节镜下“人”字缝线固定治疗后交叉韧带胫骨止点撕脱骨折  

Arthroscopic treatment of posterior cruciate ligament avuision fracture with knotted suture

作　　者：张青松[1] 李涛[1] 方禹舜[1] 谈鸿飞 王俊文[1] 勘武生[1] 

机构地区：[1]华中科技大学同济医学院附属普爱医院运动医学科,武汉430033

出　　处：《中华创伤骨科杂志》2016年第11期998-1000,共3页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨关节镜下“人”字缝线固定治疗后交叉韧带（PCL）胫骨止点撕脱骨折的疗效。方法回顾性分析2013年1月至2014年12月期间收治的17例PCL胫骨止点撕脱骨折患者资料。男11例，女6例；年龄为21～57岁，平均38．7岁。骨折按Meyers—McKeever分型：Ⅲ型11例，Ⅳ型6例。术中将缝线在骨折块腱骨结合部打结后呈“人”字形向骨折块远端经胫骨平台后方的2个骨道穿出，通过在胫骨平台前方骨桥上打结来实现骨折块的复位与加压固定。记录患者的疼痛视觉模拟评分（VAS）、膝关节Lysholm评分、胫骨平台后向移位KT-2000值及术后并发症的发生情况。结果17例患者术后获7～19个月（平均13．5个月）随访。术后1～2个月（平均1．3个月）X线片示骨痂形成，无骨折复位丢失现象发生。末次随访时所有患者骨折均获骨性愈合，膝关节平均活动范围：伸直2．0°±3．5°，屈曲134．2°±12．5°；膝关节Lysholm评分平均为89．3分（83～95分）；屈膝90°时胫骨平台最大力下后向移位KT-2000值平均为1．5mm（0．5～5．3mm）。1例患者术后发生胫后深静脉血栓形成，2例患者胫骨平台后向移位〉5mm。结论关节镜下“人”字缝线复位固定技术能有效复位和固定PCL胫骨止点撕脱骨折，恢复PCL的张力，提高胫骨平台的后向稳定性，减少继发性骨性关节炎的发生，疗效良好。Objective To evaluate the outcomes of arthroscopic treatment of posterior cruciate ligament （PCL） avulsion fracture with knotted suture. Methods We arthroscopically treated 17 patients with PCL avulsion fractures from January 2013 through December 2014. They were 11 males and 6 females, from 21 to 57 years of age （mean, 38.7 years）. By Meyers-McKeever classification, there were type m in 11 cases and type IV in 6. The PCL tendon close to the avulsion bone was surrounded with non-absorbable suture; 2 arms of the suture were knotted and then retrieved fi＇om 2 bone tunnels drilled from the anterior tibia to the lower part of fracture bone bed. Fine reduction and fixation was achieved by tying the sutures at the bone bridge of the anterior tibia. X-tray or CT scan was taken routinely to confirm the bone healing during postoperative follow-up. Visual analogue scale （VAS）, Lyshohn knee scoring and the posterior migration of the tibial plateau under KT-2000 were also recorded. Results The 17 patients obtained an average follow-up of 13.5 months （from 7 to 19 months）. X-ray films at 1 to 2 months after surgery （mean, 1.3 months） showed porosis but no loss of fi＇acture reduction. The final follow-ups showed bony union in all. The average ranges of motion were extension of 2.0°± 3.5° and flexion of 134.2°± 12.5°; the average Lysholm knee score was 89.3 （from 83 to 95） . The average posterior migration of the tibial plateau under KT-2000 with the knee flexed at 90° was 1.5 mm （from 0.5 to 5.3 ram）. Deep vein thrombosis occurred in one case, and 2 cases had a posterior migration of the tibial plateau of more than 5 ram. Conclusion Treatment of PCL avulsion fracture with knotted suture under arthroscopy can result in effective reduction and reliable fixation to restore the PCL tension, enhance the posterior stability of tibial plateau, and reduce incidence of secondary traumatic osteoarthritis.

关 键 词：后交叉韧带 胫骨骨折 骨折固定术 内 关节镜检查 

分 类 号：R687.4[医药卫生—骨科学]