关节镜下后内侧双入路应用双Endobutton治疗后交叉韧带撕脱骨折
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摘要
目的探讨关节镜下后内侧双入路采用双Endobutton带袢钢板固定后交叉韧带胫骨止点撕脱骨折的疗效。方法自2016年2月至2017年8月收治14例新鲜后交叉韧带胫骨止点撕脱骨折,其中男10例,女4例;年龄23～50岁,平均36.6岁。手术采用前内、前外侧及后内侧高、低位4入路进行关节镜下手术治疗。术前及术后6个月采用Lysholm膝关节功能评分、国际膝关节文献委员会(international knee documentation committee,IKDC)主观膝关节评分标准进行疗效评价,应用KT-2000客观评估膝关节稳定性。结果 14例均获随访,随访时间6～24个月,平均12个月。术后3个月时骨折均达到临床愈合标准,未发生骨折延迟愈合或不愈合。术后6个月随访患者的Lysholm评分从术前(36.5±4.9)分提高到术后(87.0±5.2)分(P<0.05),IKDC评分由术前(53.2±6.4)分提高到(82.5±5.8)分(P<0.05),差异均有统计学意义。KT-2000测量患膝与健侧胫骨后向松弛度差异:患侧屈膝90°时为(2.51±0.73)mm,健侧为(2.82±0.68)mm,差异无统计学意义(P>0.05)。结论全关节镜下后内侧双入路采用双Endobutton带袢钢板手术治疗膝关节后交叉韧带撕脱骨折,疗效满意,具有创伤小、操作简单、并发症少等优点。
Objective To investigate the effect of arthroscopic posteromedial double approaches for tibial avulsion fracture of posterior cruciate ligament fixed with double Endobutton plate.Methods From Feb.2016 to Aug.2017,14 cases of fresh tibial avulsion fracture of posterior cruciate ligament were treated by arthroscopic surgery through anterolateral,anterolateral and posteromedial high and low approaches.There were 10 males and 4 females,aged from 23 to 50 years,with an average age of 36.6 years.The clinical outcomes were evaluated by Lysholm score andthe IKDC subjective knee score before and after operation at 6 months.Knee stability was evaluated with KT-2000.Results All 14 cases were followed up for 6 to 24 months,with an average of 12 months.At 3 months after operation,all the fractures met the clinical healing criteria,and no delayed union or nonunion occurred.The Lysholm scoreafter 6 months of follow-up increased from(36.5±4.9) preoperatively to(87.0±5.2)postoperatively(P<0.05).And the IKDC score was improved from preoperative 53.2±6.4 to(82.5±5.8)(P<0.05).The difference was statistically significant.KT-2000 measurementresults revealed that there were no significant differences between the surgical knee and the normal knee:(2.51±0.73)mm versus(2.82±0.68)mm(P>0.05).Conclusion The technique of arthroscopic posteromedial double approaches and fixationwith double Endobutton plateis satisfactoryin the treatment of avulsion of the posterior cruciate ligament of the knee,and has the advantages of less trauma,simple operation and less complications.
Objective To investigate the effect of arthroscopic posteromedial double approaches for tibial avulsion fracture of posterior cruciate ligament fixed with double Endobutton plate.Methods From Feb.2016 to Aug.2017,14 cases of fresh tibial avulsion fracture of posterior cruciate ligament were treated by arthroscopic surgery through anterolateral,anterolateral and posteromedial high and low approaches.There were 10 males and 4 females,aged from 23 to 50 years,with an average age of 36.6 years.The clinical outcomes were evaluated by Lysholm score andthe IKDC subjective knee score before and after operation at 6 months.Knee stability was evaluated with KT-2000.Results All 14 cases were followed up for 6 to 24 months,with an average of 12 months.At 3 months after operation,all the fractures met the clinical healing criteria,and no delayed union or nonunion occurred.The Lysholm scoreafter 6 months of follow-up increased from(36.5±4.9) preoperatively to(87.0±5.2)postoperatively(P<0.05).And the IKDC score was improved from preoperative 53.2±6.4 to(82.5±5.8)(P<0.05).The difference was statistically significant.KT-2000 measurementresults revealed that there were no significant differences between the surgical knee and the normal knee:(2.51±0.73)mm versus(2.82±0.68)mm(P>0.05).Conclusion The technique of arthroscopic posteromedial double approaches and fixationwith double Endobutton plateis satisfactoryin the treatment of avulsion of the posterior cruciate ligament of the knee,and has the advantages of less trauma,simple operation and less complications.
引文
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[7]Andri GT,Klineberg EO,Wahl CJ,et al.Treatment of posterior cruciate ligament tibial avulsion fractures through a modifed open posterior approach:operative technique and 12-to48-month outcomes[J].J Orthop Trauma,2008,22(5):317-324.
[8]Jazayeri SM,EsmailiJah AA,Karami M.A safe postero-medial approach to posterior cruciate ligament avulsion fracture[J].Knee Surg Sports TraumatolArthrosc,2009,17(3):244-247.
[2]Zhang X,Cai G,Xu J,et al.A minimally invasive postero-medial approach with suture anchors for isolated tibialavulsion fracture of the posterior cruciate ligament[J].Knee,2013,20(2):96-99.
[3]张磊,孔德明,王浩军.后内侧入路在治疗复杂胫骨平台骨折中的应用和疗效分析[J].实用骨科杂志,2015,21(7):648-651.
[4]LysholmJ,Gillquist J.Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale[J].Am J Sports Med,1982,10(3):150-154.
[5]张国宁,王友.膝关节评分标准的评估[J].中华外科杂志,2006,44(16):1141-1143.
[6]Paine R,Lowe W.Comparison of kneelax and KT-1000knee ligamentarthrometers[J].J Knee Surg,2012,25(2):151-154.
[7]Andri GT,Klineberg EO,Wahl CJ,et al.Treatment of posterior cruciate ligament tibial avulsion fractures through a modifed open posterior approach:operative technique and 12-to48-month outcomes[J].J Orthop Trauma,2008,22(5):317-324.
[8]Jazayeri SM,EsmailiJah AA,Karami M.A safe postero-medial approach to posterior cruciate ligament avulsion fracture[J].Knee Surg Sports TraumatolArthrosc,2009,17(3):244-247.