关节镜下三点缝合前交叉韧带治疗胫骨止点撕脱骨折的效果及术后功能评价  

Therapeutic outcomes of arthroscopic three-point suture of the anterior cruciate ligament for tibial avulsion fractures

作　　者：潘魏巍 张志凌[1] 严惠强 尚旭亚 Pan Weiwei;Zhang Zhiling;Yan Huiqiang;Shang Xuya(Joint Orthopedics Department,the Second Naval Hospital of the Southern Theater Command of the PLA,Sanya,Hainan Province 572000,China)

机构地区：[1]中国人民解放军南部战区海军第二医院关节骨科,海南三亚572000

出　　处：《创伤外科杂志》2024年第1期43-48,共6页Journal of Traumatic Surgery

摘　　要：目的探究关节镜下运用三点手术缝合前交叉韧带(ACL)方法治疗胫骨止点撕脱骨折的临床疗效,并对术后功能恢复情况进行评价。方法前瞻性选取2020年6月—2022年6月中国人民解放军南部战区海军第二医院关节骨科收治的101例胫骨止点撕脱骨折患者,男性45例,女性56例;年龄19~62岁,平均48.6岁;道路交通伤33例,运动损伤32例,其他36例。信封法随机分两组:两点缝合组(n=51)行关节镜下ACL传统两点缝合术,三点缝合组(n=50)行关节镜下ACL三点缝合治疗,术后均进行常规康复训练,随访1年。记录两组手术时间、术后引流量、骨折愈合时间、住院时间及负重开始时间,比较组间VAS、国际膝关节文献委员会(IKDC)评分、Lysholm评分、SF-36健康调查简表及术后并发症情况。结果两组间手术时间、术后引流量比较差异无统计学意义(P>0.05),三点缝合组骨折愈合时间、住院时间、负重开始时间均短于两点缝合组[(4.55±0.65)月vs.(4.91±0.46)月、(8.99±2.11)d vs.(10.22±2.12)d、(36.55±5.56)d vs.(44.23±6.15)d,P<0.05]。两组VAS在治疗和康复训练后均较术前下降,且术后3d及术后7d三点缝合组VAS低于两点缝合组[(3.66±0.71)分vs.(4.26±0.64)分、(1.88±0.66)分vs.(3.33±0.34)分,P<0.05]。经治疗及康复训练,两组IKDC评分、Lysholm评分均有所升高,且术后1个月及术后6个月三点缝合组的IKDC评分及Lysholm评分均高于两点缝合组[IKDC评分:术后1个月:(61.09±2.48)分vs.(49.88±3.65)分、术后6个月:(75.22±3.31)分vs.(66.33±2.78)分;Lysholm评分:术后1个月:(67.66±3.21)分vs.(56.88±3.64)分、术后6个月:(82.11±3.56)分vs.(69.45±4.66)分,P<0.05]。在进行治疗和康复训练后,两组生活质量均有所提高,且与两点缝合组相比,三点缝合组各维度评分均升高[物质生活:(60.11±5.98)分vs.(69.77±6.12)分、躯体:(69.44±6.45)分vs.(78.11±4.55)分、心理:(67.22±7.16)分vs.(78.33±6.89)分、社会功能:(61.23±8.7Objective To investigate the clinical effect of arthroscopic application of three-point suture technique to manage tibial avulsion fractures of the anterior cruciate ligament(ACL)and to evaluate the postoperative functional recovery.Methods Between Jun.2020 and Jun.2022,a prospective study was conducted on patients with tibial avulsion fractures treated at the Orthopedic Department of the Naval Hospital of the Southern Theater Command of PLA by arthroscopic repair of the ACL.There were 101 patients enrolled,with 45 males and 56 females aged 19-62 years,mean 48.6 years,including 33 road traffic injuries,32 sports injuries,and 36 others.Patients were randomly divided into two groups using the envelope method:two-point suture group(traditional twopoint suture repair of the ACL,n=51)and three-point suture group(three-point suture technique of the ACL,n=50).Both groups underwent routine postoperative rehabilitation training and were followed up for one year.The op-eration time,postoperative drainage volume,fracture healing time,length of hospital stay,and the initiation of weight-bearing activities were recorded for both groups.Furthermore,the visual analog scale(VAS),International Knee Documentation Committee(IKDC)scores,Lysholm scores,SF-36 short-form Health Survey,and postoperative com-plications were assessed and compared between the two groups.Results The surgical duration and postoperative drainage volume showed no significant differences between the two groups(P>0.05).However,the three-point su-ture group showed significantly quicker fracture healing(months,4.55±0.65 vs.4.91±0.46),shorter length of hos-pital stay(d,8.99±2.11 vs.10.22±2.12),and earlier start of weight-bearing activities(d,36.55±5.56 vs.44.23±6.15,all P<0.05).After treatment and rehabilitation training,the VAS scores in both groups decreased,and much lower in the three-point suture group at postoperative 3 d(3.66±0.71 vs.4.26±0.64)and 7 d(1.88±0.66 vs.3.33±0.34,both P<0.05);the IKDC score and Lysholm score were also improved,which were

关 键 词：胫骨止点撕脱骨折 三点手术缝合 传统ACL修补 关节镜 术后功能评价 

分 类 号：R683.42[医药卫生—骨科学]