关节镜下韧带末端缝扎固定治疗后十字韧带胫骨止点骨折

 目的探讨关节镜下韧带末端缝扎固定治疗后十字韧带（posterior cruciate ligament，PCL）胫骨止点撕脱骨折的手术方法、疗效及适应证。方法2007年6月至2009年6月，采用关节镜下韧带末端缝扎固定治疗PCL胫骨止点骨折21例，男14例，女7例；年龄13~52岁，平均31.5岁；其中青少年患者5例。骨折块横径> 10mm 8例，5~10mm 11例，＜5mm 2例。在关节镜下使用两股5号爱惜邦缝线在韧带末端缝扎，从胫骨前内侧向胫骨骨床的4∶30和7∶30钻两个2.5mm骨隧道，经骨隧道将缝线拉出，固定于门型钉上。术后观察骨折复位情况、愈合时间、膝关节的松弛度及活动度、对青少年患者骨骺的影响，测量K T-2000值，采用L ysholm评价系统对膝关节功能进行评价。结果骨折复位均满意；骨折均愈合，平均愈合时间2.5个月。21例患者均获得随访，随访时间10～24个月，平均13.5个月。1例患者后抽屉试验（+），但其终点为硬性；所有患者伸膝均不受限，2例患者有10°~ 15°屈膝受限，平均屈膝角度为140.5°±3.8°；KT-2000为平均（1.2±0.4）mm，Lysholm评分为平均（95.2±2.7）分。结论关节镜下采用韧带末端缝合固定的方法治疗PCL胫骨止点撕脱骨折，固定可靠，可较好恢复患膝的功能；适用于合并关节内其他结构损伤的患者、粉碎性骨折或骨折块较小的患者、骨骺未闭的青少年患者。

Arthroscopic treatment of tibia insertion avulsion fracture of the posterior cruciate ligament with suture the end of ligament

Objective To discuss the indications and efficacy for treating tibia insertion avulsion fracture of the posterior cruciate ligament(PCL)by the mean of the end of ligament suture via arthroscopy.Methods Twenty-one cases of tibia insertion avulsion fracture of PCL were treated with suture the end of ligament via arthroscopy from June 2007 to June 2009,including 14 males,7 females,with a mean age of 31.5 years(range,13-52 years).The insertion avulsion fragment was fixed to the tibia with two strands of 5Ethibond threads via arthroscopy.Two bone tunnels(2.5 mm in width)were made from the anterior part of the tibia to the posteromedial(at 4:30 toward)and posterolateral(at 7:30 toward)of the tibia bone bed respectively.Then the sutures were pulled out through the two bone tunnels and tied to the door-nail.Reduction and healing of the avulsion fragment,relaxation and mobility degree of knee,and the influence of osteoepiphysis to teenage patients were observed after surgery.KT-2000 value and Lysholm score were calculated.Results All cases were followed up from 10 to 24 months,with an average of 13.5 months.All the fragments were united without displacement in all cases according to X-ray films.One case showed posterior drawer test(+),but the tibia insertion was healed.The knee extension in all cases was unlimited,and 10° to 15° flexion limitation was found in 2 cases.The average range of flexion was 140.5°±3.8°.On average,KT-2000 value was(1.2±0.4)mm,Lysholm score was 95.2±2.7.Conclusion For treating the avulsion fracture of PCL,suture the end of ligament via arthroscopic transfixion can get a reliable fixation and a satisfied function of the knee,especially,which is suitable for the small avulsion fracture fragments,the adolescent patients with premature epiphysis.