关节镜下极高位入路与切开内固定治疗PCL撕脱骨折  

Clinical Comparison of Arthroscopic Treatment through Ultrahigh Posteromedial Portal Versus Miniopen Reduction and Internal Fixation for Avulsion Fracture of the Tibial Attachment of the Posterior Cruciate Ligament

作　　者：王新民[1] 刘飞[1] 赵海霞 王巍[1] 

机构地区：[1]秦皇岛市第一医院骨科二病区,河北秦皇岛066000

出　　处：《实用骨科杂志》2018年第1期19-24,共6页Journal of Practical Orthopaedics

摘　　要：目的比较关节镜下极后高位入路与小切口切开复位内固定术治疗后交叉韧带(posterior cruciate ligament,PCL)胫骨止点撕脱骨折的临床疗效。方法回顾性分析2011年3月至2017年3月收治的68例急性PCL胫骨止点撕脱骨折,根据不同时期不同手术方式分为两组:关节镜组(A组)33例,男20例,女13例,平均年龄为(30.2±2.1)岁,采用关节镜下极后高位入路置钉治疗手术技术;小切口切开复位内固定组(B组)35例,男25例,女10例,平均年龄(28.3±3.6)岁,采用腘窝后内侧小切口入路切开复位内固定,内固定材料为4.0 mm空心钉,结合手术前后膝关节X线片、CT和MRI,术后随访分别采用国际膝关节文献委员会膝关节评估表(international knee documentation committee,IKDC)和Lysholm评分进行主观膝关节功能评价,应用KT-2000及PDT试验客观评估膝关节稳定性。结果两组68例所有患者术程顺利并获得随访,随访12~18个月。关节镜组(A组)平均手术时间(65.51±4.83)min,小切口切开复位内固定组(B组)手术时间(45.36±3.29)min,两组比较差异有统计学意义,术后3个月所有骨折均愈合。末次随访时A组患者PDT试验阴性率为87.9%(29/33),B组为91.4%(32/35),末次随访时A组Lysholm评分为(95.51±4.83)分,IKDC评分为(93.34±3.61)分;B组Lysholm评分为(96.40±3.78)分,IKDC评分为(95.67±5.44)分,两组比较差异无统计学意义(P>0.05)。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:A组患膝为(2.47±1.02)mm,健膝为(2.05±0.92)mm,二者之间比较差异无统计学意义;B组为(2.53±0.82)mm,健膝为(2.24±0.73)mm,二者之间比较差异无统计学意义;KT-2000测量末次随访屈膝90°时A组与B组患膝之间比较差异无统计学意义。结论关节镜下极后高位入路置钉治疗后交叉韧带止点撕脱骨折是一种可靠的内固定方法,关节镜组与小切口切开复位内固定组均可以获得满意疗效,但切开复位组手术时间更短,能保�Objective To compare the clinical outcome of arthroscopic reduction and internal fixation（ARIF）through ultrahigh posteromedial portal and mini-open reduction and internal fixation（ORIF）for avulsion fracture of the tibial attachment of the posterior cruciate ligament（PCL）.Methods From March 2011 to March 2017,68 cases of the avulsion fracture of Posterior Cruciate Ligament were treated operatively in our hospital.Thirty-three patients were treated with ARIF through ultrahigh posteromedial portal（Group A）.Thirty-five patients were treated with ORIF with cannulated screws（Group B）.There were 20 males and 13 females in group A,with a mean age of（30.2±2.1）years old,and 25 males and 10 females in group B,with a mean age of（28.3±3.6）years old.The PCL and avulsion bony fragment were fixed with 4.0 mm canulated screw（Synthes）.The outcome were measured by X-ray,CT or MRI testing.Patients were available for clinical evaluation with KT-2000 arthrometer measurements and PDT tests,and knee function with the Intemational Knee Documentation Committee（IKDC）,Lysholm scores.Results All the patients were followed up at an averge of 12~18 months.Primary union were achieved in all the fractures 3 months postoperatively.The average time of operations were（65.51±4.83）min in Group A and（45.36±3.29）min in Group B.There were no significant differences between group A and group B regarding the PDT negative rate（87.9% versus 91.4%）,the Lysholm score（95.51±4.83 versus 96.40±3.78）,the IKDC score（93.34±3.61 versus 95.67±5.44）.There were no significant differences between the surgical knee and the normal knee regarding the the results of KT-2000 at the tensile fore of 134 N,Group A：（2.47±1.02）mm vs（2.05±0.92）mm,Group B：（2.53±0.82）mm vs（2.24±0.73）mm at 90°of flexion.There were no significant differences between Group A and Group B of the surgical knee regarding the the results of KT-2000（2.47±1.02）mm vs（2.53±0.82）mm at 90°of flexion.Conclusion The

关 键 词：关节镜 极后高位入路 小切口 后交叉韧带 撕脱骨折 

分 类 号：R683.42[医药卫生—骨科学]