全关节镜下治疗后交叉韧带胫骨止点撕脱骨折的临床效果分析

［摘要］ 目的探讨全关节镜下双后内侧入路TigerTape线带绑扎治疗后交叉韧带胫骨止点撕脱骨折的方法及临床效果。 方法选取后交叉韧带胫骨止点撕脱骨折患者22例，采用全关节镜下双后内侧入路复位TigerTape线带绑扎固定撕脱骨折块的治疗方法。记录其手术方法、手术时间、术后并发症、术后功能锻炼方式及骨折愈合情况，比较手术前后膝关节活动度的变化及后抽屉试验的结果，评估患侧膝关节术后功能改善情况。 结果手术时间60~100 min，平均（79.52±17.42） min，微创手术出血均少量，术中及术后均未输血，术后第2天发生下肢深静脉血栓5例，其中肌间静脉血栓3例，胫前静脉血栓1例，胫后静脉血栓1例，给予抗凝药物治疗1周后，复查下肢深静脉彩色超声均未见血栓。所有患者手术后均未发生肺血栓栓塞、感染、神经和血管损伤、膝关节黏连僵硬等其他严重并发症。随访所有患者，时间为6~24个月，平均（16.91±6.23）个月。骨折愈合时间4～8个月，平均（5.93±121）个月，均达到临床愈合标准，未发生骨折延迟愈合或不愈合。术后6个月后抽屉试验查体均为阴性。末次随访时膝关节活动度及Lysholm评分均高于术前（P＜0.05）。 结论全关节镜下双后内侧入路TigerTape线带绑扎治疗后交叉韧带胫骨止点撕脱骨折手术操作相对简单，创伤小，安全性高，固定效果可靠，可有效恢复膝关节功能，临床疗效确切，值得在临床推广。

Clinical analysis of total arthroscopic ligation fixation in the treatment of posterior cruciate ligament avulsion fracture

［Abstract］ Objective〖HTSS〗To explore the clinical effect of TigerTape ligation fixation through double posteromedial portal under arthroscopy in the treatment of posterior cruciate ligament avulsion fracture. 〖WTHZ〗Methods〖HTSS〗Twenty-two patients with posterior cruciate ligament avulsion fracture were treated with TigerTape line bandage fixation. The treatment method, operation time, complications, postoperative functional training and fracture healing were recorded. The joint stability, extension and flexion were compared to evaluate the joint function before and after surgery. 〖WTHZ〗Results〖HTSS〗The average operation time was 79.52±17.42(60-100) minutes. There was no blood transfusion during and after operation. At two days after surgery, deep vein thrombosis(DVT) was detected in 5 patients in which 3 were in intermuscular veins, 1 was in anterior tibial vein and 1 was in posterior tibial vein. All patients showed no evidence of DVT after 1 week of anticoagulation treatment. No serious complications such as infection, blood vessel or nerve injury, pulmonary embolism or joint stiffness was found. The follow-up duration average 16.91±6.23(6-24) months. The average healing time of fracture was 5.93±1.21(4-8) months. X-ray examination showed that all patients met the clinical healing standard on 6 months after operation. No malunion or nonunion was found. Posterior drawer test was negative. All patients returned to normal activity after operation. After operation the Lysholm score was significantly improved(P＜0.05). 〖WTHZ〗Conclusion〖HTSS〗In patients with posterior cruciate ligament avulsion fracture, TigerTape ligation fixation through double posteromedial portalunder arthroscopy can effectively fix the fracture and restore the knee joint function with the superiority of surgery safety, minimal invasion and faster recovery.