关节镜双后内入路与切开手术治疗急性单纯后交叉韧带胫骨止点撕脱骨折早期疗效对比

目的:比较关节镜双后内入路与切开手术治疗急性单纯后交叉韧带胫骨止点撕脱骨折的疗效差异。方法:回顾性分析2016年6月至2020年6月经手术治疗的52例急性单纯性后交叉韧带胫骨止点撕脱骨折患者的临床资料,按手术方案不同分为两组,关节镜组27例患者行关节镜双后内入路手术治疗,其中男16例,女11例,年龄19~52(34.9±9.2)岁;切开复位组25例患者行膝关节后内侧切口手术治疗,其中男14例,女11例,年龄18~54(33.7±8.4)岁。观察并比较两组患者手术时间、切口长度、术中出血量、住院时间、住院费用、术后愈合情况、并发症以及术后12个月Lysholm、IKDC评分。结果:两组患者均顺利完成手术,无血管、神经损伤。52例均获得随访,时间6~24(15.0±1.7)个月。关节镜组手术时间、住院费用大于切开复位组(P<0.05);关节镜组术中出血量、切口长度、住院时间小于切开复位组(P<0.05);关节镜组和切开复位组术后12个月Lysholm评分分别为(95.9±1.7)分和(86.4±1.2)分,均较术前的(49.1±2.3)分和(48.9±1.1)分显著提高(P<0.05);关节镜组和切开复位组术后12个月IKDC总分分别为(96.9±1.5)分和(87.1±1.4)分,均较术前的(47.6±4.1)分和(48.1±3.9)分显著提高(P<0.05);关节镜组术后12个月膝关节Lysholm、IKDC评分均高于切开复位组(P<0.05)。结论:关节镜双后内入路治疗急性单纯后交叉韧带胫骨止点撕脱骨折,早期效果满意,疗效优于传统开放手术,具有创伤小、恢复快、操作简便等优点。

Comparative study on arthroscopic double posterior medial approach versus open surgery for acute simple posterior cruciate ligament tibial avulsion fracture

Objective: To compare difference in clnical efficacy between arthroscopic double posterior internal approach and incisional surgery for acute simple posterior cruciate ligament tibial avulsion fractures.Methods: Totally 52 patients with acute simple posterior cruciate ligament tibial avulsion fractures treated from June 2016 to June 2020 were retrospectively analyzed and divided into two groups according to different surgical protocols,27 patients in arthroscopic group were treated with arthroscopic double posterior internal approach,including 16 males and 11 females,aged from 19 to 52 years old,with an average age of (34.9±9.2) years old;25 patients in open reduction group were treated with posterior medial knee incision,including 14 males and 11 females,aged from 18 to 54 years old,with an average age of(33.7±8.4) years old. Operation time,incision length,intraoperative bleeding,hospitalization days,hospitalization cost,fracture healing,complications,postoperative Lysholm score and IKDC score at 12 months were observed and compared between two groups.Results: All patients in both groups were completed opertaion successfully without vascular or nerve injury,and 52 patients were followed up from 6 to 24 months with an average of (15.0±1.7) months. Operation time and hospitalization cost in arthroscopic group were significantly greater than those in open reduction group(P<0.05);intraoperative bleeding,incision length,and hospitalization days in arthroscopic group were less than those in open reduction group(P<0.05);preoperative Lysholm score in arthroscopic group and open reduction group were 49.1±2.3 and 48.9±1.1 respectively,and improved to 95.9±1.7 and 86.4±1.2 at 12 months after operation respectively(P<0.05);preoperative IKDC scores in arthroscopic group and open reduction group were 47.6±4.1 and 48.1±3.9 respectively,and improved to 96.9±1.5 and 87.1±1.4 at 12 months after operation(P<0.05).Conclusion: Arthroscopic double posterior internal approach for acute simple posterior cruciate ligament tibial stop avulsion fracture has satisfactory early results and better efficacy than traditional open surgery,which has advantages of less trauma,faster recovery and easier operation.