膝关节后侧“S”形切口与后内侧小切口带线锚钉治疗后交叉韧带胫骨止点撕脱骨折的效果比较  

Comparison of the efficacy of posterior"S"shape incision versus medial small incision with suture anchor for treating avulsion fractures of the tibial insertion of the posterior cruciate ligament

作　　者：陈天钢 张恒 宋帅 张雷 戴士峰[1] 谢坤南 Chen Tiangang;Zhang Heng;Song Shuai;Zhang Lei;Dai Shifeng;Xie Kunnan(Department of Joint 2,Tangshan Second Hospital,Tangshan 063000,China;Department of Emergency,Tangshan Second Hospital,Tangshan 063000,China;Department of Radiology,Tangshan Second Hospital,Tangshan 063000,China)

机构地区：[1]河北省唐山市第二医院关节二科,唐山063000 [2]河北省唐山市第二医院急诊科,唐山063000 [3]河北省唐山市第二医院放射科,唐山063000

出　　处：《中国综合临床》2025年第2期133-139,共7页Clinical Medicine of China

基　　金：河北省医学科学研究课题(20231730)。

摘　　要：目的对比分析经膝关节后侧“S”形切口与后内侧小切口应用带线锚钉治疗后交叉韧带(posterior cruciate ligament,PCL)胫骨止点撕脱骨折的临床效果。方法回顾性分析2021年3月至2023年5月唐山市第二医院关节二科收治的符合手术适应证的PCL胫骨止点撕脱骨折患者的临床资料,其中Meyers-McKeever分型Ⅱ型25例,Ⅲ型41例。其中采用后侧“S”形切口入路手术的32例患者为对照组;根据组间基线特征匹配的原则,选择同期采取后内侧小切口入路手术的34例患者为观察组。两组患者均采用带线锚钉固定撕脱骨折。收集两组患者的手术指标及术后1、3、6个月时的伤侧膝关节Lysholm评分、国际膝关节文献委员会(the international knee documentation committee knee evaluation form,IKDC)评分、视觉模拟评分(visual analogue scale,VAS)、膝关节屈伸活动范围、双侧胫骨后移距离差值(患者双侧胫骨后移距离并计算二者差值)及术后并发症发生率。通过对比分析,评价膝关节术后功能恢复情况。计数资料组间比较采用χ^(2)检验,正态分布的计量资料组间比较采用t检验。结果观察组患者切口长度[(5.71±1.85)cm]、术中出血量[(74.87±20.74)mL]、手术时间[(48.76±6.46)min]均小于对照组[(12.45±1.52)cm、(120.29±31.12)mL、(61.14±10.23)min],差异均有统计学意义(t值分别为16.21、7.02、5.92,均P<0.001)。术后3、6个月,观察组患者的Lysholm评分[(79.67±3.08)、(91.16±2.23)分]及IKDC评分[(84.67±5.08)、(93.16±3.23)分]均高于对照组[(65.29±3.84)、(79.52±2.98)、(79.29±4.84)、(85.32±3.98)分],差异均有统计学意义(t值分别为16.72、18.04、4.40、8.81,均P<0.001)。术后3、6个月,对照组患者VAS评分[(2.83±0.38)、(2.12±0.34)分]显著高于观察组[(2.41±0.25)、(1.73±0.49)分],差异均有统计学意义(t值分别为5.34、3.73,均P<0.001)。两组患者术后6个月骨折均愈合,观察组和对照组患者伤侧膝关节�ObjectiveTo compare and analyze the clinical efficacy of using a posterior"S"shape incision versus a medial small incision with suture anchors in the treatment of avulsion fractures at the tibial insertion of the posterior cruciate ligament(PCL).MethodsA retrospective study was conducted on clinical data from patients with PCL tibial avulsion fractures who met surgical criteria and were treated at Department of Joint 2,Tangshan Second Hospital from March 2021 to May 2023.Among those patients,there were 25 cases classified as Meyers-McKeever typeⅡand 41 cases as typeⅢ.32 patients who underwent surgery through the posterior"S"shape incision served as the control group;based on matched baseline characteristics,34 patients who underwent surgery through the medial small incision were selected as the observation group.Both groups received fixation of the avulsion fracture with suture anchors.Surgical indicators,as well as Lysholm scores,International Knee Documentation Committee(IKDC)scores,visual analogue scale(VAS)scores,range of motion(ROM)of the injured knee,the difference in posterior tibial translation between both sides(calculated by measuring the posterior translation on both sides),and the incidence of postoperative complications were collected at 1,3,and 6 months post-surgery.Comparative analyses were conducted to evaluate postoperative functional recovery.Chi-square tests were used for categorical data comparison,and t-tests were employed for normally distributed continuous data.ResultsThe observation group had shorter incision lengths((5.71±1.85)cm),less intraoperative blood loss((74.87±20.74)mL),and shorter operation times((48.76±6.46)min)compared to the control group((12.45±1.52)cm,(120.29±31.12)mL,(61.14±10.23)min),and the differences were statistically significant(t values were 16.21,7.02,5.92,respectively;all P<0.001).At 3 and 6 months post-surgery,the Lysholm((79.67±3.08),(91.16±2.23)points)and IKDC scores((84.67±5.08),(93.16±3.23)points)in the observation group were significantly higher

关 键 词：后交叉韧带胫骨止点撕脱骨折 “S”形切口 小切口 带线锚钉 

分 类 号：R687.3[医药卫生—骨科学]