关节镜下高强线固定治疗后交叉韧带下止点撕脱骨折

目的介绍全关节镜下高强度线捆绑固定治疗后交叉韧带（PCL）下止点撕脱骨折的手术方法和临床效果。方法关节镜下常规探查后，通过后内、后外人路将骨块修整、新鲜化后，采用PCL重建导向器引导并由关节外向关节内骨折块边缘钻孔制备两个骨道，引入高强度线，环线PCL打结后，从骨道引到前方，于胫骨前方皮下打结固定。术后在支具保护4～6周后开始康复训练。结果2010年1月至2012年6月，采用此方法治疗PCL下止点撕脱骨折18例，结果显示骨折解剖复位、愈合良好。术后2例失访，16例得到随访，时间7～30个月（平均13．6个月）。术后6周内膝关节屈曲可达90°，术后8周伸屈恢复正常，术后12周行走正常。术后无血管、神经并发症发生，平均3个月骨折愈合。Lysholm评分从术前（38．9±4．9）分增加到（95．2±3．8）分（t：27．3，P〈0．001），IKDC评分从术前（57．1±10．3）分增加到（94．3±4．4）分（t=21．8，P〈0．001），术后评分与术前比较均有统计学差异。KT3000检测后向位移从术前（3．6±0．39）mm下降到（1．1±0．27）mm，手术前后评分有统计学差异（t=17．5，P〈0．001）。15例患者均恢复术前运动水平。结论全关节镜下高强度线捆绑固定手术方法能直接对PCL下止点撕脱骨折复位、硬固定，不需另外切开操作，骨块固定稳固，达到了切开直视下骨折直接复位固定的效果，固定可靠，利于术后早期康复锻炼，不需二次手术切开取内固定，手术快捷，功能恢复良好。

Arthroscopic treatment of tibial avulsion fracture of posterior cruciate ligament with high-strength suture

Objective To evaluate the outcome of arthroscopic treatment using high-strength line for tibial avulsion fracture of posterior cruciate ligament （PCL）. Methods From January 2010 to June 2012, a total of 18 cases of PCL tibial avulsion fracture were enrolled and followed up after surgery. All the cases were treated by arthroscopy. Both the avulsed bone block and the tibia bone bed were refreshed. The procedure was completed with the assistance of PCL director drill guide. High-strength sutures were used during the reduction to fix the avulsed bone by posterior middle portal. Rehabilitation began early postoperatively. Results Reduction of the avulsion fragmentwas obtained in all cases. 16 cases were followed up for seven to 30 months （average 13.6） ; two cases were out of follow-up. In the 16 followed-up patients, flexion and extension were back to normal within six weeks, and normal walk was achieved in 12 weeks. The bone healing was good without any vascular or nerve complications. All the patients regained the activity level before surgery. The average Lysholm scores increased from （38. 9 ±4. 9） points to （95.2±3.8） points, and the average IKDC scores increased from （57. 1± 10. 3） points to （94. 3 ±4. 4）.Posterior displacement declined from （ 3.6±0. 39 ） mm preoperative to （ 1.1 ±0. 27 ）mm postoperation according to KT3000 test. Conclusions Arthroscopie vertical fixation by high-strength suture is a simple, safe, reliable, and minimalinvasive treatment for PCL tibial avulsion fracture. It is good for early postoperative rehabilitation. The stability of the knee could be achieved without secondary operation of removing the internal fixation devices.