关节镜下Ethibond缝线复位固定治疗后交叉韧带胫骨止点撕脱骨折的临床疗效

目的探讨关节镜下Ethibond缝线复位固定治疗后交叉韧带(posterior cruciate ligament,PCL)胫骨止点撕脱骨折的临床效果。方法对2015年2月至2017年12月我院收治的22例PCL胫骨止点撕脱骨折病人,在关节镜下常规前内、前外侧入路结合双后内侧入路显露骨折,将PCL重建定位器置入并在其引导下由前内向后于撕脱骨折床3点和9点处钻出导针,制造两骨隧道。术中使用双根5号Ethibond缝线在韧带后方骨块近侧打结,经胫骨双骨隧道将缝线拉出于胫骨前侧,充分复位骨折块,缝线收紧打结固定。术后定期随访,了解骨折复位、愈合情况及活动度,采用KT 1000测量及后抽屉试验评估膝关节稳定性,比较手术前后的Lysholm评分、Tegner评分、国际膝关节评分委员会(International Knee Documentation Committee,IKDC)评分。结果随访时间为19~28个月,平均24.5个月。术后6周骨折均愈合,复位良好。术后6个月,所有病人后抽屉试验均为阴性,无伸膝、屈膝受限,平均屈膝活动度为138.5°±3.5°。手术前后的KT 1000测量值分别为(10.9±0.7)mm、(1.5±0.6)mm,Lysholm评分分别为(36.5±4.9)分、(94.2±3.3)分,Tegner评分分别为(2.6±0.8)分、(6.7±0.4)分;IKDC评分:术前C级7例(31.82%)、D级15例(68.18%),术后A级21例(95.45%)、B级1例(4.55%)。上述指标手术前后的数值比较,差异均有统计学意义(P均<0.05)。结论关节镜下经胫骨双骨隧道应用5号Ethibond缝线复位固定治疗PCL胫骨止点撕脱骨折,固定方法简便可靠,临床疗效满意。

Clinical efficacy of Ethibond suture reduction and fixation under arthroscopy for posterior cruciate ligament tibial avulsion fracture

Objective To investigate the clinical efficacy of Ethibond suture reduction and fixation under arthroscopic for posterior cruciate ligament(PCL)tibial avulsion fracture.Methods From February 2015 to December 2017,in 22 patients with PCL tibial avulsion fractures,conventional arthroscopy and anterior lateral approach combined with double postero medial approach revealed fractures under arthroscopy.The PCL reconstruction locator was placed and guided from the anterior medial to the posterior direction.Guide needles were drilled at 3 and 9 o'clock on the avulsion fracture bed to create a two bone tunnel.During the operation,two No.5 Ethibond sutures were used to tie the proximal bone mass behind the ligament.The suture was pulled out of the anterior side of the tibia through the tibial double bone tunnel to fully reduce the fracture mass.The suture was tightened and tied.Regular follow up after surgery was performed to understand fracture reduction,healing and activity.KT 1000 measurement and posterior drawer test were used to evaluate knee stability.Lysholm score,Tegner score,and International Knee Documentation Committee(IKDC)score before and after surgery were compared.Results The follow up time ranged from 19 to 28 months,with an average of 24.5 months.All fractures healed and the reduction was good at 6th week.At 6th month after operation,all patients had negative posterior drawer tests,no knee extension,and no knee flexion limitation.The average knee flexion activity was 138.5°±3.5°.KT 1000 values before and after surgery were(10.9±0.7)mm and(1.5±0.6)mm,Lysholm scores were 36.5±4.9 and 94.2±3.3,and Tegner scores were 2.6±0.8 and 6.7±0.4 respectively.For IKDC score,there were 7 cases of grade C(31.82%),15 cases of grade D(68.18%),21 cases of grade A(95.45%),and 1 case of grade B(4.55%).All the indexes above showed statistically significant differences(all P<0.05).Conclusion Arthroscopic transtibial double bone tunnel application of No.5 Ethibond suture reduction and fixation to treat PCL tibial avulsion fracture is simple and reliable,and the clinical efficacy is satisfactory.