关节镜下TightRope袢钢板固定治疗后交叉韧带止点撕脱骨折的临床疗效观察

目的 探讨关节镜下TightRope袢钢板固定治疗后交叉韧带（PCL）止点撕脱骨折的临床疗效。方法 系列病例报告。纳入南京医科大学附属逸夫医院骨科2019年1月—2020年10月PCL止点撕脱骨块的患者28例,其中男20例、女8例,年龄37~65（45.7±7.8）岁,White Ⅱ型15例、Ⅲ型13例。患者均采用关节镜下TightRope袢钢板固定治疗。观察手术时间,术后切口愈合情况,并发症发生情况以及骨折愈合时间;比较术后12个月与术前Lysholm膝关节功能评分、疼痛视觉模拟评分法（VAS）评分及国际膝关节文献委员会（IKDC）评分的差异。结果 28例患者均顺利完成手术,手术时间50~90（67±8）min。患者术后恢复良好,切口均一期愈合。无血管神经损伤、关节内血肿和感染等并发症发生。28例患者均获随访12~14个月,平均12.5个月。随访期间复查X线显示骨折无移位,无固定物松动、脱落或断裂,骨折均愈合,愈合时间2~4（2.5±0.6）个月。随访期间,2例屈膝受限,1例轻度伸膝受限,1例膝关节后方不适,予相应处理后症状缓解;其余24例患者均恢复良好,无特殊不适。28例患者术前患膝疼痛VAS评分（6.8±0.9）分、Lysholm膝关节功能评分（45.7±6.3）分、IKDC评分（18.3±5.5）分,术后12个月分别为（2.2±0.7）分、（86.2±5.3）分、（95.8±3.1）分。患者术后12个月Lysholm膝关节功能评分、IKDC评分均高于术前,疼痛VAS评分均低于术前,差异均有统计学意义（t=49.95、114.35、18.95,P值均<0.001）。结论 关节镜下TightRope袢钢板固定治疗PCL止点撕脱骨折,操作简单,可获得较好的临床疗效。

Clinical efficacy observation of arthroscopic treatment of posterior cruciate ligament avulsion fractures with TightRope steel plates

Objective To perform a clinical study of the arthroscopic treatment of posterior cruciate ligament avulsion fractures with TightRope steel plates. Methods A case series study was conducted. A total of 28 patients (20 males and 8 females) with PCL avulsion fractures were recruited from Sir Run Run Hospital Affiliated with Nanjing Medical University from January 2019 to October 2020. The patients were aged 37-65 (45.7±7.8) years old. Using the White classification, 15 cases were classified under Type Ⅱ, and 13 cases were classified under Type Ⅲ. All patients were treated with a TightRope steel plate under arthroscopy, and the postoperative incision healing, complications, and fracture healing time were observed. The Lysholm knee joint function score, pain visual analogue scale (VAS) score, and International Knee Joint Literature Committee (IKDC) score were compared 12 months before and after the operation. Results The operation was successfully performed in all 28 patients. The operation time was 50-90 (67±8) min. The patients recovered well, and the incisions healed in Stage I. No complications, such as vascular and nerve injury, intra-articular hematoma, and infection, occurred. All 28 patients were followed up for 12-14 months (mean 12.5 months). The X-ray conducted during the follow-up period showed that the fractures were all healed without displacement. No loosening, shedding, or breakage of the fixation was observed. The fracture healing time was 2-4 (2.5±0.6) months. During the follow-up period, two cases had limited knee flexion, one case had mild knee extension limitation, and one case had discomfort behind the knee joint. The symptoms were relieved after corresponding treatment. The 24 other patients recovered well, and no particular discomfort was reported. The preoperative VAS, Lysholm knee function, and IKDC scores of the 28 patients with knee pain were (6.8±0.9), (45.7±6.3), and (18.3±5.5), respectively. Twelve months after the operation, the pain VAS, Lysholm knee function, and IKDC scores were (2.2±0.7), (86.2±5.3), and (95.8±3.1), respectively. The Lysholm knee joint function and IKDC scores 12 months after the operation were higher than those before the operation, and the pain VAS score after the operation was lower than that before the operation; the differences were statistically significant (t=49.95, 114.35, 18.95; all P values <0.05). Conclusion Arthroscopic treatment of PCL avulsion fractures with TightRope steel plates is simple and has a good clinical effect.