切开复位内固定治疗膝关节后交叉韧带止点撕脱骨折病人围术期深静脉血栓的发生规律

目的探讨后正中入路齿状垫片空心钉治疗膝关节后交叉韧带止点撕脱骨折病人围术期下肢深静脉血栓形成(deep venous thrombosis,DVT)的发生规律。方法前瞻性分析2014年1月至2017年12月收治的膝关节后交叉韧带止点撕脱骨折病人58例,其中男48例,女10例;年龄为18~64岁,平均33.5岁。按Meyers McKeever分型:2型16例,3型30例,4型12例。所有病人均采用后正中入路齿状垫片空心钉固定韧带止点撕脱骨折块。分别在术前、术后进行双下肢静脉超声判断DVT的发生情况,分析其发生规律。结果14例(24.14%,14/58)术前发现DVT,其中远端血栓8例,近端血栓4例,混合血栓2例;术后DVT发生率增加至36.21%(21/58),其中11例远端血栓,7例近端血栓(其中5例为腘静脉血栓),3例混合血栓。7例术前无血栓病人中在术后4例出现远端血栓,2例出现近端血栓,1例出现混合血栓;1例术前为远端血栓的病人在术后变化为近端血栓;其中有50例病人术前、术后血栓未发生变化(37例无血栓病人,7例远端血栓,4例近端血栓,2例混合血栓)。结论膝关节后交叉韧带止点撕脱骨折病人术前及术后血栓形成均以远端血栓为主,术后DVT发生率有所增加。使用后正中入路齿状垫片空心钉治疗膝关节后交叉韧带止点撕脱骨折,可以获得牢固的固定,在术中暴露时应轻柔操作,降低对腘静脉的牵拉损伤,减少下肢静脉血栓的发生。

Perioperative occurrence of deep venous thrombosis in patients with avulsion fracture of posterior cruciate ligament of knee joint undergoing open reduction and internal fixation

Objective To investigate the occurrence of deep venous thrombosis (DVT) in lower extremities of patients with posterior cruciate ligament avulsion fracture treated by dentate spacer hollow nail through posterior median approach. Methods From January 2014 to December 2017, 58 patients with avulsion fracture of posterior cruciate ligament of knee joint were treated, including 48 males and 10 females, aged 18-64 years, with an average age of 33.5 years. According to Meyers-McKeever classification, 16 cases were fallen into type 2, 30 cases into type 3, and 12 cases into type 4. All patients were treated with dentate gasket hollow nail through posterior median approach to fix avulsion fracture of ligament insertion. The occurrence of DVT was judged by venous ultrasound of both lower extremities before and after operation, and the regularity of DVT occurrence was analyzed. Results Preoperative thrombosis occurred in 14 patients (24.14%, 14/58), including distal thrombosis in 8 cases, proximal thrombosis in 4 cases and mixed thrombosis in 2 cases. The incidence of thrombosis increased to 36.21% (21/58), including 11 cases of distal thrombosis, 7 cases of proximal thrombosis and 3 cases of mixed thrombosis, of which 5 cases of proximal thrombosis were popliteal vein thrombosis. Among the 7 patients without thrombus before operation, 4 had distal thrombus, 2 had proximal thrombus and 1 had mixed thrombus. One patient with distal thrombus before operation changed to proximal thrombus after operation. Among them, 50 patients had no change of thrombus before and after operation (37 patients without thrombus, 7 patients with distal thrombus, 4 patients with proximal thrombus and 2 patients with mixed thrombus). Conclusion Thrombosis in patients with posterior cruciate ligament stop-point avulsion fractures was predominantly distal preoperative and postoperative, and the incidence of DVT increased. The treatment of avulsion fracture of posterior cruciate ligament of knee joint with dentate spacer hollow nail through posterior median approach can obtain firm fixation. It should be operated gently during operation to reduce the traction injury of popliteal vein and the occurrence of venous thrombosis of lower extremity.