全内镜下袢钢板悬吊固定治疗后交叉韧带胫骨止点撕脱骨折的临床疗效  

Clinical outcomes of all-endoscopic endobutton suspension fixation for posterior cruciate ligament tibial avulsion fractures

作　　者：郭思远 罗信 冯仕明 GUO Siyuan;LUO Xin;FENG Shiming(Department of Sports Medicine,Xuzhou Clinical College of Xuzhou Medical University,Xuzhou Central Hospital,Xuzhou,Jiangsu 221009,China)

机构地区：[1]徐州医科大学徐州临床学院(徐州市中心医院)运动医学科,江苏221009

出　　处：《中国骨与关节损伤杂志》2024年第12期1275-1281,共7页Chinese Journal of Bone and Joint Injury

基　　金：江苏省卫生健康委科研项目(H2023023);徐州市医学重点人才培养项目(XWRCHT20220047)。

摘　　要：目的 观察全内镜下袢钢板悬吊固定治疗后交叉韧带胫骨止点撕脱骨折的临床疗效。方法 回顾性分析2020-01—2023-03采用全内镜下袢钢板悬吊与膝后内侧倒L入路切开复位两种手术方法治疗的88例后交叉韧带胫骨止点撕脱骨折,观察组46例采用全内关节镜下袢钢板悬吊固定,对照组42例采用传统倒L入路切开复位内固定,比较两组手术时间、切口愈合情况、住院时间、骨折愈合情况,以及术后膝关节活动度、IKDC评分、Lysholm评分、Tegner评分、股四头肌肌力对称性指数、单腿垂直跳跃高度肢体对称性指数(Limb symmetry index,LSI)、ACL-RSI评分。结果 所有患者均获得随访,随访时间12~16个月,平均14个月。观察组与对照组均无末梢血管神经损伤症状及骨折不愈合、内固定松动情况发生,对照组出现2例切口脂肪液化。观察组手术时间(58.32±10.45)min、住院时间(6.8±1.7)d,对照组手术时间(65.17±11.28)min、住院时间(10.2±2.3)d;观察组手术时间(t=-2.957,P=0.004)、住院时间(t=-7.825,P<0.001)均较对照组少,差异有统计学意义。重复测量方差分析结果表明膝关节活动度(F_(组间*时间)=55.284,P<0.001)、IKDC评分(F_(组间*时间)=7.915,P<0.001)、Lysholm评分(F_(组间*时间)=5.192,P=0.001)、LSI指数(F_(组间*时间)=9.374,P<0.001)的组间与时间交互效应显著,患者的膝关节功能在不同术式治疗下术后不同时间的变化趋势不同。Tegner评分、股四头肌肌力对称性指数和ACL-RSI评分的时间主效应均显著,在不同时间点的差异均有统计学意义(P<0.05),且术后评分均较术前明显提高。主体间效应检验显示两组间评分差异有统计学意义(P<0.05),两种术式的效果不全相同。结论 全内镜下袢钢板悬吊固定治疗后交叉韧带胫骨止点撕脱骨折是一种安全、创伤小、可靠的治疗方案,术后早期功能恢复满意,且股四头肌肌力对称性指数、单腿垂直跳跃高Objective To evaluate the clinical efficacy of all-arthroscopic endobutton suspension fixation in treating posterior cruciate ligament(PCL) tibial avulsion fractures.Method A retrospective analysis was conducted on 88 patients with PCL tibial avulsion fractures treated between January 2020 and March 2023.Two surgical methods were compared:46 patients in the observation group underwent all-arthroscopic endobutton suspension fixation,while 42 patients in the control group received traditional open reduction and internal fixation via a posteromedial inverted-L approach.The operative time,incision healing,hospital stay,fracture healing,and postoperative outcomes-including knee joint range of motion,IKDC score,Lysholm score,Tegner score,quadriceps strength symmetry index,single-leg vertical jump limb symmetry index(LSI),and ACL-RSI score were compared between the two groups.Results All patients were followed up for 12 to 16 months,with an average of 14months.There were no peripheral neurovascular injury,nonunion,or internal fixation loosening in either group.However,two patients in the control group experienced incisional fat liquefaction.The observation group showed a shorter operative time(58.32±10.45) minutes and hospital stay(6.8±1.7) days compared to the control group(65.17±11.28) minutes and(10.2±2.3)daysrespectively,with statistically significant differences in both operative time(t=-2.957,P=0.004) and hospital stay(t=-7.825,P<0.001).Repeated measures ANOVA showed significant interaction effects between group and time for knee range of motion(F_interaction=55.284,P<0.001),IKDC score(F_interaction=7.915,P<0.001),Lysholm score(F_interaction=5.192,P=0.001),and LSI index(F_interaction=9.374,P<0.001),indicating different postoperative trends in knee function depending on the surgical technique.The main effect of time was significant for the Tegner score,quadriceps strength symmetry index,and ACL-RSI score,with postoperative scores significantly higher than preoperative ones(P<0.05).Intergroup analysis showed sig

关 键 词：后交叉韧带胫骨止点撕脱骨折 关节镜 切开复位 袢钢板 

分 类 号：R686.5[医药卫生—骨科学]