无结锚钉与空心钉固定后交叉韧带胫骨撕脱骨折  

Knotless anchor versus cannulated screw for fixation of posterior cruciate ligament tibial avulsion fracturese

作　　者：彭俊洋 张云鹏 陈晖[1] 魏俊成 田纪伟[1] PENG Jun yang;ZHANG Yun-peng;CHEI Hui;WEI Jun-cheng;TIAN Ji-wei(Department of Orthopedics,Benq Hospital,Nanjing Medical University,Nanjing 210019,China)

机构地区：[1]南京医科大学附属明基医院骨科,江苏南京210019

出　　处：《中国矫形外科杂志》2024年第16期1461-1466,共6页Orthopedic Journal of China

摘　　要：[目的]比较关节镜下无结锚钉与空心钉固定技术治疗后交叉韧带(posterior cruciate ligament,PCL)胫骨止点撕脱骨折疗效。[方法]回顾性分析2013年10月—2020年10月本院收治的急性PCL胫骨止点撕脱性骨折28例患者的临床资料,均实施关节镜下复位固定手术。根据医患沟通结果,14例患者采用锚钉固定,另外14例采用空心钉固定。比较两组围手术期、随访和影像资料。[结果]所有患者均顺利完成手术,无严重并发症。两组在手术时间、手术切口大小、失血量、切口愈合等级和住院时间的差异均无统计学意义(P>0.05)。锚钉组在术中透视[(0)次vs(2.1±0.4)次,P<0.001]和术后止痛药使用[(2.1±0.5)d vs(3.1±0.6)d,P<0.001]均显著优于空心钉组,但是前者医疗费用[(29677.3±2406.3)元vs(18605.2±953.7)元,P<0.001]显著高于后者。两组患者恢复完全负重的时间差异无统计学意义(P>0.05)。与术后3个月相比,末次随访时两组患者VAS、IKDC、Lysholm评分和ROM均显著改善(P<0.05);相应时间点,两组间上述指标的差异均无统计学意义(P>0.05)。影像方面,两组间骨折复位质量和骨折愈合时间的差异均无统计学意义(P>0.05)。至末次随访时,两组患者均无明显膝关节退变加重的影像改变。[结论]无结锚钉与空心钉固定技术治疗PCL胫骨止点撕脱骨折均可获得良好的手术效果。相比之下,无结锚钉术后舒适度高,但治疗费用更高。[Objective]To compare the clinical efficacy of arthroscopic knotless anchor versus cannulated screw for fixation of posteri-or cruciate ligament(PCL)tibial avulsion fractures.[Methods]A retrospective study was performed on 28 patients who received arthroscop-ic reduction and fixation of acute PCL tibial avulsion fractures in our hospital from October 2013 to October 2020.According to doctor-pa-tient communication,14 patients had fractures fixed with knotless anchors,while the other 14 patients were with cannulated screws.The perioperative,follow-up and imaging data were compared between the two groups.[Results]All patients were operated on smoothly without serious complications.There were no significant differences in operation time,incision length,blood loss,incision healing grade and hospi-tal stay between the two groups(P>0.05).The anchor groups proved significantly superior to the screw group in terms of intraoperative fluo-roscopy[(0)times us(2.1±0.4)times,P<0.001]and postoperative analgesic use[(2.1±0.5)days us(3.1±0.6)days,P<0.001],despite of the fact that the former spent significantly higher medical cost than the latter[(29677.3±2406.3)yuan vs(18605.2±953.7)yuan,P<0.001]There was no significant difference between the two groups in the time to regain full-weight bearing activity(P>0.05).Compared with those 3 months after surgery,the VAS,IKDC and Lysholm scores,as well as ROM significantly improved in both groups at the last follow-up(P<0.05),which were not statistically significant between the two groups at any time points accordingly(P>0.05).Regarding to imaging,there were no statistically significant differences in fracture reduction quality and fracture healing time between the two groups(P>0.05).At the last follow-up,there was no significant imaging change of worsening knee degeneration in both groups.[Conclusion]Both knotless anchor and cannulated screw fixation do achieve good consequences for PCL tibial avulsion fractures.In contrast,the knotless anchor has higher postoperative comfort but hig

关 键 词：后交叉韧带 胫骨止点撕脱骨折 关节镜术 无结锚钉 空心钉 

分 类 号：R683.42[医药卫生—骨科学]