关节镜下缝线联合穿肌腱双重复位纽扣钢板技术治疗后交叉韧带胫骨止点撕脱骨折  

Arthroscopic suture combined with perforator tendon double reduction and Endobutton plate technique for the treatment of tibial avulsion fracture of posterior cruciate ligament

作　　者：温志嘉 刘伟乐[1] 郑少伟[1] 黄守镔 钟浩博[1] Wen Zhijia;Liu Weile;Zheng Shaowei;Huang Shoubin;Zhong Haobo(Department of Joint Surgery and Sports Medicine,First People′s Hospital of Huizhou,Huizhou 516003,China)

机构地区：[1]惠州市第一人民医院关节外科与运动医学科,惠州516003

出　　处：《中华创伤杂志》2023年第9期801-806,共6页Chinese Journal of Trauma

基　　金：广东省基础与应用基础研究基金地区培育项目(2022A1515140046,2022A1515140151,2022A1515140071);广东省中医药局科研项目(20221400,20222241);惠州市临床重点专科培育项目;惠州市第一人民医院科研培育与创新基金项目(2022ZD001,2022ZD002);惠州市科技计划(2022CZ010146,2022CZ010423)。

摘　　要：目的探讨关节镜下缝线合并穿肌腱双重复位纽扣钢板技术治疗后交叉韧带(PCL)胫骨止点撕脱骨折的疗效。方法采用回顾性病例系列研究分析2018年1月至2022年10月惠州市第一人民医院收治的32例PCL胫骨止点撕脱骨折患者的临床资料,其中男19例,女13例;年龄18~65岁[(42.8±15.0)岁]。Meyers⁃MckeeverⅡ型27例,Meyers⁃MckeeverⅢ型5例。患者均采用关节镜下缝线联合穿肌腱双重复位纽扣钢板技术治疗PCL胫骨止点撕脱骨折。出院前通过X线片观察骨折复位情况。术后3个月通过CT观察骨折愈合情况,并采用后抽屉试验评估膝关节稳定性。比较术前、术后3个月及末次随访时膝关节主动活动度、视觉模拟评分(VAS)、Lysholm评分、国际膝关节文献委员会(IKDC)评分。观察术中及术后并发症发生情况。结果患者均获随访6~36个月[(19.7±8.7)个月]。出院前X线片显示骨折复位满意,术后3个月CT可见骨折线不同程度模糊。术后3个月,2例患者出现Ⅰ度后抽屉试验阳性,其余均为阴性。膝关节主动活动度由术前54.2°(45.0°,70.0°)提高至术后3个月及末次随访时的124.8°(120.0°,130.0°)、130.6°(125.0°,135.0°)(P均<0.01)。VAS由术前5.1(3.0,7.0)分降至术后3个月及末次随访时的1.2(1.0,2.0)分、0.1(0.0,0.0)分(P均<0.01)。Lysholm评分由术前31.2(24.3,37.0)分提高至术后3个月及末次随访时的73.6(69.3,78.8)分、92.6(91.0,95.0)分(P均<0.01)。IKDC评分由术前(20.9±7.1)分提高至术后3个月及末次随访时的(59.2±8.9)分、(77.5±7.0)分(P均<0.01)。与术后3个月比较,末次随访时膝关节活动度明显改善,VAS明显下降,Lysholm评分及IKDC评分明显提高(P均<0.05)。术中未发生神经血管损伤,术后无切口感染、下肢静脉血栓形成等并发症。结论关节镜下缝线联合穿肌腱双重复位纽扣钢板技术治疗PCL胫骨止点撕脱骨折,骨折端复位良好、愈合率高,关节稳定,关节活动度改善Objective To evaluate the efficacy of arthroscopic suture combined with perforator tendon double reduction and Endobutton plate technique for the treatment of tibial avulsion fracture of posterior cruciate ligament(PCL).Methods A retrospective case series study was conducted to analyze the clinical data of 32 patients with tibial avulsion fracture of PCL,who were admitted to First People′s Hospital of Huizhou from January 2018 to October 2022.There were 19 males and 13 females,with age range of 18⁃65 years[(42.8±15.0)years].By the Meyers-Mckeever classicfication,27 patients were type II,and 5 type III.All the patients were treated with arthroscopic suture combined with perforator tendon double reduction and Endobutton plate technique to fix PCL tibial avulsion fracture at the insertion point.The fracture reduction was observed by X⁃ray films before discharge.Three months postoperatively,the fracture healing was observed by CT imaging,and the stability of knee joint was evaluated by posterior drawer test.The knee active range of motion,visual analogue score(VAS),Lysholm score,and International Knee Documentation Committee(IKDC)score were used to evaluate the pain and knee function before operation,at 3 months after operation,and at the last follow⁃up.Intraoperative and postoperative complications were observed.Results All the patients were followed up for 6⁃36 months[(19.7±8.7)months].The X⁃ray films showed satisfactory reduction of the fracture before discharge,and the CT showed that the fracture line was blurred to various degrees at 3 months after operation.Two patients had degree I positive posterior drawer test at 3 months after operation,and the rest were negative.The knee active range of motion was improved from 54.2°(45.0°,70.0°)preoperatively to 124.8°(120.0°,130.0°)at 3 months postoperatively and to 130.6°(125.0°,135.0°)at the last follow⁃up(all P<0.01).The VAS was decreased from 5.1(3.0,7.0)points preoperatively to 1.2(1.0,2.0)points at 3 months postoperatively and to 0.1(0.0,0.

关 键 词：后交叉韧带 骨折 撕脱性 关节镜检查 缝线 

分 类 号：R687.3[医药卫生—骨科学]