关节镜下极后高位入路空心螺钉固定与标准入路缝线固定修复后交叉韧带胫骨止点撕脱骨折  

Arthroscopic treatment with canulated screw fixation through very high-posteromedial portal approach versus double bundle suture fixation for avulsion fracture of tibial attachment of posterior cruciate ligament

作　　者：王新民[1] 刘飞[1] 赵海霞 王巍[1] 王健全 

机构地区：[1]秦皇岛市第一医院骨科二病区,河北省秦皇岛市066000

出　　处：《中国组织工程研究》2017年第35期5655-5660,共6页Chinese Journal of Tissue Engineering Research

基　　金：2017年度河北省医学科学研究重点课题计划~~

摘　　要：背景:课题组改良设计了关节镜下极后高位入路置钉手术技术直接进行骨折块复位内固定,目的是可以对骨折块直接进行垂直加压,使骨折块所受压力均匀分布在愈合线上,且手术操作方便,固定牢固,但其临床疗效还有待进一步证实。目的:比较关节镜下极后高位入路空心螺钉固定与标准入路缝线固定治疗后交叉韧带胫骨止点撕脱骨折的临床疗效。方法:纳入2011年1月至2017年5月在秦皇岛市第一医院骨科二病区收治的60例急性后交叉韧带胫骨止点撕脱骨折患者(骨折块横径>10 mm),根据不同时期手术方式不同分为2组:空心钉组(n=31),采用关节镜下极后高位空心螺钉固定;缝线组(n=29),采用关节镜下标准后内入路双股缝线内固定。比较2组患者的一般情况;术后随访分别采用国际膝关节文献委员会膝关节评估表(IKDC)和Lysholm评分进行主观膝关节功能评价;应用KT-2000及后抽屉试验客观评估膝关节稳定性。结果与结论:(1)所有患者术程顺利并获得随访,随访时间为6-12个月;(2)空心钉组平均手术时间为(63.49±3.97)min,缝线组平均手术时间为(87.28±3.46)min,差异有显著性意义(P<0.05)。术后3个月,所有患者骨折均愈合;(3)末次随访时空心钉组患者后抽屉试验阴性率为90%,Lysholm评分为94.89±4.75,IKDC评分为94.01±3.25;缝线组患者后抽屉试验试验阴性率为90%,Lysholm评分为95.56±3.63,IKDC评分为95.52±4.72,2组间比较均无明显差异(P>0.05);(4)KT-2000测量末次随访屈膝90°时患膝与健膝胫骨后向松弛度差异:空心钉组患膝(2.53±1.02)mm,健膝(2.12±0.83)mm;缝线组患膝为(2.65±0.82)mm,健膝为(2.19±0.63)mm,2组患者患膝与健膝之间比较无明显差异(P>0.05);且2组间患膝KT-2000比较无明显差异;(5)关节镜下极后高位入路置钉与缝线固定治疗后交叉韧带胫骨止点撕脱骨折均可以获得满意疗效;对于后交叉韧带胫骨止点撕脱骨折块直径>10 BACKGROUND： This team modified the arthroscopic reduction and internal fixation with canulated screw through very high-posteromedial portal approach to perform direct compression. Thus, the pressure of the fracture block is evenly distributed on the healing line, and the operation is convenient and fixed firmly, but its clinical effect remains to be further confirmed. OBJECTIVE： To compare the clinical outcome of arthroscopic reduction and internal fixation with canulated screw through very high-posteromedial portal approach and double bundle suture fixation for avulsion fracture of the tibial attachment of posterior cruciate ligament. METHODS： From January 2011 to May 2017, 60 cases of the avulsion fracture of posterior cruciate ligament （transverse diameter of fracture block 〉 10 mm） were treated operatively at the Orthopedics and Arthroscopic Ward Two, First Hospital of Qinhuangdao, China. According to different modes of operation in different periods, patients were assigned to two groups. In the canulated screw group （n=31）, patients were treated with canulated screw through very high-posteromedial portal approach. In the suture group （n=29）, patients were treated with double bundle suture fixation through posteromedial portal approach. General conditions were compared between the two groups. Knee function was assessed with the Intemational Knee Documentation Committee and Lysholm scores. Knee stability was evaluated with KT-2000 and posterior drawer test. RESULTS AND CONCLUSION： （1） All the patients were followed up （range 6-12 months）. （2） The average operation time was （63.49±3.97） minutes in the canulated screw group and （87.28±3.46） minutes in the suture group （P 〈 0.05）. At 3 months after surgery, all the patients were healed. （3） At the final follow-up, in the canulated screw group, the negative rate of posterior drawer test was 90%. Lysholm scores were 94.89±4.75. IKDC scores were 94.01±3.25. In the suture group, the negative rate of posterior dr

关 键 词：骨科植入物 关节植入物 关节镜 极后高位入路 空心螺钉固定 缝线固定 后交叉韧带 撕脱骨折 KT-2000 后抽屉试验 Lysholm评分 IKDC评分 

分 类 号：R318[医药卫生—生物医学工程]