后交叉韧带胫骨撕脱骨折线袢缝合两种外口固定比较  

Comparison of two kinds of outlet fixation of loop suture for posterior cruciate ligament tibial avulsion fracture

作　　者：邓永杰 赵甲军 张振[1] 左坦坦 于杰 樊东晓 刘振辉 郝志全 DENG Yong-jie;ZHAO Jia-jun;ZHANG Zhen;ZUO Tan-tan;YU Jie;FAN Dong-xiao;LIU Zhen-hui;HAO Zhi-quan(Department of Orthopedics,Henan Provincial Peoples Hospital,Henan University,Zhengzhou 450003,China)

机构地区：[1]河南大学河南省人民医院骨科,河南郑州450003

出　　处：《中国矫形外科杂志》2024年第6期519-524,共6页Orthopedic Journal of China

基　　金：河南省医学科技攻关计划联合共建项目(编号:LHGI20230002,LHGI20230076)。

摘　　要：[目的]比较扣板与垫圈桩螺钉线袢固定膝关节后交叉韧带(posterior cruciate ligament,PCL)胫骨止点撕脱骨折的临床疗效。[方法]回顾性分析2020年9月—2023年3月在本院行关节镜下线袢固定膝关节PCL胫骨止点撕脱骨折折43例患者的临床资料。根据医患沟通结果,21例采用胫骨隧道前口扣板固定,另外22例采用垫圈桩螺钉固定。比较两组围手术期情况、随访资料和影像资料。[结果]扣板组的手术时间显著少于螺钉组[(51.0±5.2)min vs(58.4±5.2)min,P<0.001],但两组在切口总长度、术中失血量、下地行走时间、住院时间的差异均无统计学意义(P>0.05)。所有患者均获随访12个月以上,平均(20.2±4.6)个月,两组完全负重活动时间差异无统计学意义(P>0.05)。随着术后时间的推移,两组Lysholm评分、IKDC评分均显著增加(P<0.05),而后抽屉试验等级显著减少(P<0.05)。术前、术后3个月和末次随访,两组Lysholm评分、IKDC评分和后抽屉试验差异均无统计学意义(P>0.05)。影像方面,两组骨折复位质量,骨折愈合时间的差异均无统计学意义(P>0.05)。[结论]关节镜下线袢固定PCL胫骨止点撕脱骨折,使用扣板和垫圈桩螺钉固定均能获得良好的临床效果,但前者手术时间更少。[Objective]To compare the clinical outcomes of suture loop with button plate(BP)versus post washer screw(PWS)outletfixations for posterior cruciate ligament(PCL)tibial avulsion fractures.[Methods]A retrospective study was performed on 43 patients whoreceived arthroscopic suture loop fixation of PCL tibial avulsion fractures in our hospital from September 2020 to March 2023.According tothe results of doctor-patient communication,21 patients had the suture loop fixed by BP at the anterior outlet of the tibial tunnel,while theother 22 patients were fixed by PWS.The perioperative conditions,follow-up data and imaging data were compared between the twogroups.[Results]The BP group consumed significantly less operative time than the PWS group[(51.0±5.2)min vs(58.4±5.2)min,P<0.001],however,there were no significant differences in the total incision length,intraoperative blood loss,postoperative walking time andhospital stay between the two groups(P>0.05).All patients in both groups were followed up for more than 12 months,with an average of(20.2±4.6)months,and there was no significant difference in the time to resume full weight-bearing activities between the two groups(P>0.05).With the passage of postoperative time,Lysholm score and IKDC score were significantly increased in both groups(P<0.05),whilethe posterior drawer test grade was significantly declined(P<0.05).There were no significant differences in Lysholm score,IKDC score andpost-drawer test between the two groups before surgery,3 months after surgery and the last follow-up(P>0.05).In terms of imaging,therewere no significant differences in fracture reduction quality and fracture healing time between the two groups(P>0.05).[Conclusion]In ar-throscopic suture loop fixation of PCL tibial avulsion fractures,both BP and PWS fastenings at the anterior outlet do obtain good clinicalconsequences,but the former consumed operation time considerably less.

关 键 词：关节镜 后交叉韧带 撕脱骨折 缝线袢 扣板 垫圈桩螺钉 

分 类 号：R684.41[医药卫生—骨科学]