关节镜与切开手术治疗后交叉韧带胫骨止点骨折的疗效比较
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摘要
[目的]比较关节镜下复位固定与切开复位内固定治疗后交叉韧带胫骨止点撕脱性骨折的临床疗效。[方法]2014年3月～2018年3月本院收治急性后交叉韧带胫骨止点撕脱性骨折患者41例,随机分为两组,21例采用关节镜下克氏针缝线张力带固定(关节镜组),20例采用膝关节后内侧切口空心螺钉固定(切开复位组),比较两组的手术时间、切口长度、术后下地时间、住院时间、骨折解剖复位比例、骨折愈合时间、末次随访Lysholm评分及术后并发症等情况。[结果]两组患者均顺利手术,均无切口相关并发症。关节镜组手术时间(84.29±5.98) min明显长于切开复位组(59.75±7.86) min,切口长度(4.19±0.40) cm明显小于切开复位组(6.80±0.52) cm,术后下地时间(2.14±0.65) d明显早于切开复位组(3.80±1.64) d,住院时间(10.81±2.62) d明显小于切开复位组(13.70±4.60) d,差异均具有统计学意义(P<0.05)。关节镜组21例中16例获得解剖复位,切开复位组20例均获得解剖复位,差异具有统计学意义(P<0.05)。两组骨折愈合时间、末次随访Lysholm评分比较差异无统计学意义(P>0.05)。[结论]关节镜下克氏针缝线张力带固定和切开复位空心钉固定治疗后交叉韧带胫骨止点撕脱性骨折均可获得良好的手术效果。关节镜手术切口更短,术后下地时间更早,住院时间更短,但手术操作难度大,手术时间长且复位更加困难。
[Objective] To compare the clinical outcomes of arthroscopic versus open reduction and internal fixation for tibial avulsion fracture of posterior cruciate ligament(PCL). [Methods] From March 2014 to March 2018, a total of 41 patients with acute tibial avulsion fracture of PCL were randomly divided into two groups. Of them, 21 patients received arthroscopic reduction and internal fixation(ARIF), while the remaining 20 patients underwent open reduction and internal fixation(ORIF).The operation time, incision length, postoperative out-of-bed time, hospitalization time, complications, ratio of anatomic reduction of fracture, fracture healing time and Lysholm score were compared between the two groups. [Results] All the patients in both group had operation performed smoothly without serious complication. The ARIF group consumed significantly longer operation time than the ORIF group [(84.29±5.98) min versus(59.75±7.86) min, P<0.05], although the former took significantly shorter incision [(4.19±0.40) cm versus(6.80±0.52) cm, P<0.05], postoperative out-of-bed time [(2.14±0.65) d versus(3.80±1.64) d, P<0.05] and hospitalization time [(10.81±2.62) d versus(13.70±4.60) d, P<0.05] than the latter. Anatomic reduction was achieved in(16/21) patients of the ARIF group, while(20/20) patients of the ORIF group, which proved statistically significant(P<0.05). However, there were no statistically significant differences between the two groups regarding to the fracture healing time and Lysholm scores at the latest follow up(P>0.05). [Conclusion] Both ARIF and ORIF achieve satisfactory clinical outcomes for tibial avulsion fracture of PCL. Despite of taking shorter incision, postoperative out-of-bed time and hospitalization time, the ARIF consumes longer operation time associated with more complicated surgical operation, and more difficulty in fracture reduction.
[Objective] To compare the clinical outcomes of arthroscopic versus open reduction and internal fixation for tibial avulsion fracture of posterior cruciate ligament(PCL). [Methods] From March 2014 to March 2018, a total of 41 patients with acute tibial avulsion fracture of PCL were randomly divided into two groups. Of them, 21 patients received arthroscopic reduction and internal fixation(ARIF), while the remaining 20 patients underwent open reduction and internal fixation(ORIF).The operation time, incision length, postoperative out-of-bed time, hospitalization time, complications, ratio of anatomic reduction of fracture, fracture healing time and Lysholm score were compared between the two groups. [Results] All the patients in both group had operation performed smoothly without serious complication. The ARIF group consumed significantly longer operation time than the ORIF group [(84.29±5.98) min versus(59.75±7.86) min, P<0.05], although the former took significantly shorter incision [(4.19±0.40) cm versus(6.80±0.52) cm, P<0.05], postoperative out-of-bed time [(2.14±0.65) d versus(3.80±1.64) d, P<0.05] and hospitalization time [(10.81±2.62) d versus(13.70±4.60) d, P<0.05] than the latter. Anatomic reduction was achieved in(16/21) patients of the ARIF group, while(20/20) patients of the ORIF group, which proved statistically significant(P<0.05). However, there were no statistically significant differences between the two groups regarding to the fracture healing time and Lysholm scores at the latest follow up(P>0.05). [Conclusion] Both ARIF and ORIF achieve satisfactory clinical outcomes for tibial avulsion fracture of PCL. Despite of taking shorter incision, postoperative out-of-bed time and hospitalization time, the ARIF consumes longer operation time associated with more complicated surgical operation, and more difficulty in fracture reduction.
引文
[1]李智尧,张磊,刘劲松,等.关节镜下胫骨端RigidFix、股骨端IntraFix固定技术重建后交叉韧带[J].中国微创外科杂志,2014,20(1):7-11.
[2]Iwata S,Suda Y,Nagura T,et al.Dynamic instability during stairdescent in isolated PCL-deficient knees:what affects abnormal posterior translation of the tibia in PCL-deficient knees[J].Knee Surg Sports Traumatol Arthrosc,2 007,15(6):705-711.
[3]齐勇,王韵廷,黎飞猛,等.改良膝关节后侧入路治疗后交叉韧带胫骨止点撕脱性骨折[J].实用骨科学杂志,2017,23(3):273-275.
[4]Bali K,Parbhakar S,Saini U,et al.Open reduction and internal fixation of isolated PCL fossa avulsion fractures[J].Knee Surg Sports Traumatol Arthrosc,2012,20(2):315-321.
[5]梁广权,徐鹏雍,陈俊.膝后内侧小切口带线锚钉固定治疗后交叉韧带胫骨止点分数线骨折26例临床分析[J].广西医科大学学报,2017,34(4):559-562.
[6]Jazayeri SM,Jahesmaili AA,Karami M.A safe postero-medial approach to posterior cruciate ligament avulsion fracture[J].Knee Surg Sports Traumatol Arthrosc,2009,17(3):244-247.
[7]罗学辉,曾文磊,谢学文,等.关节镜下后交叉韧带止点撕脱性骨折手术效果分析[J].创伤外科杂志,2017,19(3):216-219.
[8]郭大伟,赵政军,王广欣,等.关节镜辅助膝关节后内小切口入路空心钉固定治疗后交叉韧带胫骨止点撕脱性骨折[J].中国实用医学,2010,5(12):87-88.
[9]陈立军.膝后交叉韧带胫骨止点撕脱性骨折的治疗[J].浙江创伤外科,2005,10(6):437-438.
[10]Zhao J,Wang J.Arthroscopic treatment of acute tibial avulsion fracture of the posterior cruciate ligament with suture fixation technique through Y-shaped bone tunnels[J].Arthroscopy,2006,22(2):172-181.
[11]Gui J,Wang L,Jiang Y,et al.Single-tunnel suture fixation of posterior cruciate ligament avulsion fracture[J].Arthroscopy,2009,25(1):78-85.
[12]郭永超,姜鑫,张益民,等.关节镜下自制缝针缝合固定后交叉胫骨止点撕脱骨折[J].中华创伤骨科杂志,2010,12(4):387-388.
[13]Sasaki SU,Damotae Albuquerque RF,Amatuzzi MM,et al.Open screw fixation versus arthroscopic suture fixation of tibial posterior cruciate ligament avulsion injuries:A mechanical comparison[J].Arthroscopy,2007,23(11):1226-1230.
[14]Chen W,Tang D,Kang L,et al.Effects of microendoscopy-assisted reduction and screw fixation through a single mini-incision on posterior cruciate ligament tibial avulsion fracture[J].Arch Orthop Trauma Surg,2012,132(4):429-435.
[15]Chen SY,Cheng CY,Chang SS,et al.Arthoscopic suture fixation for avulsion fractures in the tibial attachment of the posterior cruciate ligament[J].Arthroscopy,2012,28(10):1454-1463.
[2]Iwata S,Suda Y,Nagura T,et al.Dynamic instability during stairdescent in isolated PCL-deficient knees:what affects abnormal posterior translation of the tibia in PCL-deficient knees[J].Knee Surg Sports Traumatol Arthrosc,2 007,15(6):705-711.
[3]齐勇,王韵廷,黎飞猛,等.改良膝关节后侧入路治疗后交叉韧带胫骨止点撕脱性骨折[J].实用骨科学杂志,2017,23(3):273-275.
[4]Bali K,Parbhakar S,Saini U,et al.Open reduction and internal fixation of isolated PCL fossa avulsion fractures[J].Knee Surg Sports Traumatol Arthrosc,2012,20(2):315-321.
[5]梁广权,徐鹏雍,陈俊.膝后内侧小切口带线锚钉固定治疗后交叉韧带胫骨止点分数线骨折26例临床分析[J].广西医科大学学报,2017,34(4):559-562.
[6]Jazayeri SM,Jahesmaili AA,Karami M.A safe postero-medial approach to posterior cruciate ligament avulsion fracture[J].Knee Surg Sports Traumatol Arthrosc,2009,17(3):244-247.
[7]罗学辉,曾文磊,谢学文,等.关节镜下后交叉韧带止点撕脱性骨折手术效果分析[J].创伤外科杂志,2017,19(3):216-219.
[8]郭大伟,赵政军,王广欣,等.关节镜辅助膝关节后内小切口入路空心钉固定治疗后交叉韧带胫骨止点撕脱性骨折[J].中国实用医学,2010,5(12):87-88.
[9]陈立军.膝后交叉韧带胫骨止点撕脱性骨折的治疗[J].浙江创伤外科,2005,10(6):437-438.
[10]Zhao J,Wang J.Arthroscopic treatment of acute tibial avulsion fracture of the posterior cruciate ligament with suture fixation technique through Y-shaped bone tunnels[J].Arthroscopy,2006,22(2):172-181.
[11]Gui J,Wang L,Jiang Y,et al.Single-tunnel suture fixation of posterior cruciate ligament avulsion fracture[J].Arthroscopy,2009,25(1):78-85.
[12]郭永超,姜鑫,张益民,等.关节镜下自制缝针缝合固定后交叉胫骨止点撕脱骨折[J].中华创伤骨科杂志,2010,12(4):387-388.
[13]Sasaki SU,Damotae Albuquerque RF,Amatuzzi MM,et al.Open screw fixation versus arthroscopic suture fixation of tibial posterior cruciate ligament avulsion injuries:A mechanical comparison[J].Arthroscopy,2007,23(11):1226-1230.
[14]Chen W,Tang D,Kang L,et al.Effects of microendoscopy-assisted reduction and screw fixation through a single mini-incision on posterior cruciate ligament tibial avulsion fracture[J].Arch Orthop Trauma Surg,2012,132(4):429-435.
[15]Chen SY,Cheng CY,Chang SS,et al.Arthoscopic suture fixation for avulsion fractures in the tibial attachment of the posterior cruciate ligament[J].Arthroscopy,2012,28(10):1454-1463.