切开复位空心钉锚钉与关节镜下带袢钢板固定后交叉韧带胫骨止点撕脱骨折的疗效比较
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作者Author单位AddressE-Mail
吴荣 WU Rong 湖州市第一人民医院骨科 湖州市骨性关节炎早期诊断及治疗研究重点实验室, 浙江 湖州 313000 Department of Orthopaedics, the First People's Hospital of Huzhou, Huzhou Key Laboratory of Early Diagnosis and Treatment of Osteoarthritis, Huzhou 313000, Zhejiang, China  
张占丰 ZHANG Zhan-feng 湖州市第一人民医院骨科 湖州市骨性关节炎早期诊断及治疗研究重点实验室, 浙江 湖州 313000 Department of Orthopaedics, the First People's Hospital of Huzhou, Huzhou Key Laboratory of Early Diagnosis and Treatment of Osteoarthritis, Huzhou 313000, Zhejiang, China  
翁伟 WENG Wei 湖州市第一人民医院骨科 湖州市骨性关节炎早期诊断及治疗研究重点实验室, 浙江 湖州 313000 Department of Orthopaedics, the First People's Hospital of Huzhou, Huzhou Key Laboratory of Early Diagnosis and Treatment of Osteoarthritis, Huzhou 313000, Zhejiang, China  
杨红航 YANG Hong-hang 湖州市第一人民医院骨科 湖州市骨性关节炎早期诊断及治疗研究重点实验室, 浙江 湖州 313000 Department of Orthopaedics, the First People's Hospital of Huzhou, Huzhou Key Laboratory of Early Diagnosis and Treatment of Osteoarthritis, Huzhou 313000, Zhejiang, China  
闵继康 MIN Ji-kang 湖州市第一人民医院骨科 湖州市骨性关节炎早期诊断及治疗研究重点实验室, 浙江 湖州 313000 Department of Orthopaedics, the First People's Hospital of Huzhou, Huzhou Key Laboratory of Early Diagnosis and Treatment of Osteoarthritis, Huzhou 313000, Zhejiang, China  
孙建伟 SUN Jian-wei 湖州市第一人民医院康复医学科, 浙江 湖州 313000 Department of Rehabilitation Medicine, the First People's Hospital of Huzhou, Huzhou 313000, Zhejiang, China  
沈哲源 SHEN Zhe-yuan 湖州市第一人民医院骨科 湖州市骨性关节炎早期诊断及治疗研究重点实验室, 浙江 湖州 313000 Department of Orthopaedics, the First People's Hospital of Huzhou, Huzhou Key Laboratory of Early Diagnosis and Treatment of Osteoarthritis, Huzhou 313000, Zhejiang, China Shenzheyuan@163.com 
期刊信息:《中国骨伤》2024年,第37卷,第6期,第583-590页
DOI:10.12200/j.issn.1003-0034.20230019
基金项目:浙江省基础公益研究计划(编号:LGF19H060002);湖州市科技计划公益性应用研究项目(编号:2022GY13,2021GYB60)Fund program:Zhejiang Basic Public Welfare Research Program(No.LGF19H060002)
中文摘要:

目的: 比较后内侧入路切开复位空心钉联合锚钉固定与关节镜下Endobutton带袢钢板固定后交叉韧带(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7月至2021年12月收治的38例PCL胫骨止点撕脱骨折患者的临床资料,根据固定方式分为切开复位内固定组(后内侧入路空心钉锚钉系统固定)和关节镜固定组(关节镜下Endobutton带袢钢板固定)。切开复位内固定组20例,男16例,女4例;年龄26~74(42.9±18.8)岁;左侧13例,右侧7例;骨折Meyers-McKeever分型,Ⅱ型12例,Ⅲ型8例;后抽屉试验Ⅱ度14例,Ⅲ度6例。关节镜固定组18例,男11例,女7例;年龄24~70(53.5±13.4)岁;左侧11例,右侧7例;骨折Meyers-McKeever分型,Ⅱ型10例,Ⅲ型8例;后抽屉试验Ⅱ度11例,Ⅲ度7例。比较两组手术时间、出血量、术后即刻复位质量,并于术后6个月时比较膝关节活动度、膝关节后抽屉试验、国际膝关节文件编制委员会(International Knee Documentation Committee,IKDC)主观膝部评分表分级、KT2000稳定性评价及膝关节Lysholm功能评分。

结果: 38例患者获得随访,时间8~16(12.3±1.9)个月。所有患者未出现切口感染、骨折畸形愈合及不愈合、内固定松动等并发症。术后6个月膝关节X线片示撕脱骨折均已达到影像学愈合标准。切开复位内固定组手术时间、出血量分别为(56.4±7.1) min、(63.2±10.2) ml,关节镜固定组分别为(89.9±7.4) min、(27.7±8.7) ml,两组比较差异有统计学意义(P<0.05)。两组术后即刻复位质量(χ2=0.257,P=0.612),术后6个月膝关节活动度(t=0.492,P=0.626)、膝关节后抽屉试验(χ2=0.320,P=0.572)、膝关节IKDC分级(χ2=0.127,P=0.938)、KT2000稳定性评价(χ2=0.070,P=0.791)和膝关节Lysholm功能评分(t=0.092,P=0.282)比较,差异均无统计学意义(P>0.05)。

结论: 后内侧入路空心钉锚钉系统固定与关节镜下Endobutton带袢钢板固定PCL胫骨止点撕脱骨折均能取得满意的临床效果,且关节镜下手术出血更少,但同样学习曲线较长,手术时间较传统切开手术更长,术者需根据患者的临床情况及自身的手术倾向做出选择。
【关键词】膝关节  关节镜  骨折固定术,内  后交叉韧带  胫骨止点撕脱骨折
 
Comparison of open reduction hollow nail anchoring system with loop plate fixation under arthroscopy for the treatment of posterior cruciate ligament avulsion fractures
ABSTRACT  

Objective To compare clinical effect between open reduction and fixation with cannulated screw and threaded rivet via posteromedial approach versus arthroscopic Endobutton plate fixation in treating posterior cruciate ligament avulsion fractures.

Methods Clinical data of 38 patients with posterior cruciate ligament avulsion fractures from July 2020 to December 2021 were analyzed retrospectively,and divided into open reduction and internal fixation group (posterior medial approach hollow anchor system fixation) and arthroscopic fixation group (Endobutton with loop plate fixation under arthroscopy). There were 20 patients in open reduction and internal fixation group,including 16 males and 4 females,aged from 26 to 74 years old with an average of (42.9±18.8) years old;13 patients on the left side and 7 patients on the right side;12 patients were classified to typeⅡand 8 patiens with type Ⅲ according to Meyers-McKeever fractures classification;14 patients were gradeⅡand 6 patients were grade Ⅲ in back drawer test. There were 18 patients in arthroscopic fixation group,including 11 males and 7 females;aged from 24 to 70 years old with an average of (53.5±13.4) years old;11 patients on the left side and 7 patients on the right side;10 patients were classified to typeⅡand 8 patiens with type Ⅲ according to Meyers-McKeever fractures classification;11 patients were gradeⅡand 7 patients were grade Ⅲ in back drawer test. Operation time,blood loss,and quality of immediate reduction were compared between two groups. Knee range of motion,knee back drawer test,and International Knee Documentation Committee(IKDC) grading,KT2000 stability evaluation and Lysholm function score of knee joint were compared at 6 months after operation.

Results All patients were followed up for 8 to 16 months with an average of (12.3±1.9) months. There were no complications such as incision infection,fracture malunion or non-union,and internal fixation loosening occurred. The avulsion fractures of knee joint were reached to imaging healing standard at 6 months after operation. Operation time and blood loss in open reduction and internal fixation group were (56.4±7.1) min and (63.2±10.2) ml,while (89.9±7.4) min and (27.7±8.7) ml in arthroscopic fixation group,respectively,and had significant difference between two groups (P<0.05). There were no differences in immediate reduction quality (χ2=0.257,P=0.612),knee joint range of motion at 6 months after opertaion (t=0.492,P=0.626),knee joint rear drawer test (χ2=0.320,P=0.572),IKDC classification of knee joint (χ2=0.127,P=0.938),KT2000 stability evaluation (χ2=0.070,P=0.791),and knee Lysholm function score (t=0.092,P=0.282) between two groups.

Conclusion Posterior medial approach with hollow anchoring system fixation and arthroscopic Endobutton with loop plate fixation for the treatment of posterior cruciate ligament tibial occlusion avulsion fracture could achieve satisfactory clinical results,and arthroscopic surgery has less bleeding,but also has a longer learning curve and longer operation time than traditional incision surgery. The surgeon needs to make a choice according to clinical situation of patient and their own surgical inclination.
KEY WORDS  Knee joint  Arthroscopy  Fracture fixation, internal  Posterior cruciate ligament  Tibial avulsion fracture
 
引用本文,请按以下格式著录参考文献:
中文格式:吴荣,张占丰,翁伟,杨红航,闵继康,孙建伟,沈哲源.切开复位空心钉锚钉与关节镜下带袢钢板固定后交叉韧带胫骨止点撕脱骨折的疗效比较[J].中国骨伤,2024,37(6):583~590
英文格式:WU Rong,ZHANG Zhan-feng,WENG Wei,YANG Hong-hang,MIN Ji-kang,SUN Jian-wei,SHEN Zhe-yuan.Comparison of open reduction hollow nail anchoring system with loop plate fixation under arthroscopy for the treatment of posterior cruciate ligament avulsion fractures[J].zhongguo gu shang / China J Orthop Trauma ,2024,37(6):583~590
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