镜下锚钉与空心钉固定前交叉韧带胫骨撕脱骨折△

Suture anchor versus cannulated screw for arthroscopic fixation of anterior cruciate ligament tibial avulsion fractures

摘要:

［目的］比较镜下锚钉与空心螺钉固定治疗前交叉韧带（anterior cruciate ligament, ACL）胫骨撕脱骨折治疗的临床效果。［方法］回顾性分析 2012 年 6 月—2018 年 6 月本科镜下复位内定 ACL 胫骨撕脱骨折的 84 例患者的临床资料。依据医患沟通结果，44 例采用锚钉固定，40 例空心螺钉固定。比较两组围手术期、随访及影像结果。［结果］ 84 例患者均顺利完成手术，无血管、神经损伤。锚钉组手术时间显著长于空心钉组（P<0.05），但下地行走时间显著早于空心钉组（P<0.05）。两组其他围手术期指标的差异均无统计学意义 （P>0.05）。两组患者均获随访（25.18±4.53）个月，锚钉组恢复完全负重活动时间显著早于空心钉组（P<0.05）。术后两组轴移试验、Lachman 试验均较术前显著改善（P<0.05），相应时间点两组间差异无统计学意义（P>0.05）。随时间推移，两组患者 Tegner、Lysholm 及 IKDC 膝关节评分均显著增加（P<0.05）；术后 3 个月，锚钉组上述评分均显著优于空心钉组（P<0.05）；术后 6 个月及末次随访时上述指标的差异均无统计学意义（P>0.05）。影像方面，两组骨折复位质量的差异无统计学意义（P<0.05），锚钉组影像骨折愈合时间显著早于空心钉组（P<0.05），至末次随访两组膝关节退变 Kellgren-Lawrence 分级均无显著变化（P>0.05）。［结论］两种固定方式均可有效治疗 ACL 胫骨撕脱骨折，相比之下，锚钉固定具有骨折愈合时间短、早期疗效更佳的优势。

Abstract:

[Objective] To compare the clinical outcomes of suture anchor versus cannulated screw for arthroscopic fixation of anterior cruciate ligament (ACL) tibial avulsion fractures. [Methods] A retrospective study was conducted on a total of 84 patients who underwent arthroscopic reduction and internal fixation of ACL tibial avulsion fracture in our hospital from June 2012 to June 2018. According to doc- tor-patient communication, 44 patients had fracture fixed with suture anchors (SA) , whereas the remaining 40 patients were fixed with can- nulated screws (CS) . The perioperative, follow-up and imaging results were compared between the two groups. [Results] All the 84 pa- tients had operation performed successfully without vascular or nerve injury. Although the SA group consumed significantly longer opera- tion time (P＜0.05) , whereas resumed walking postoperatively significant earlier than CS group (P＜0.05) , there was no significant differenc- es in the other perioperative parameters between them (P＞0.05) . All patients in the two groups were followed up for (25.18±4.53) months, and the SA group resumed full weight-bearing activity significantly earlier than CS group (P＜0.05) . The knees stability revealed by pivot shift test and Lachman test significantly improved in both groups postoperatively compared with those preoperatively (P＜0.05) , whereas which was not statistically significant between them at any matching time points (P＜0.05) . The Tegner, Lysholm, and IKDC scores in- creased significantly over time in both groups (P＜0.05) , which in the SA group proved significantly superior to the CS group at 3 months af- ter surgery (P＜0.05) , whereas became not statistically significant at 6 months postoperatively and at the latest follow-up (P＞0.05) . Radio- graphically, there was no significant difference in fracture reduction quality between the two groups (P＜0.05) , but the SA group got fracture healing on images significantly earlier than the CS group (P＜0.05) . In addition, there was no significant change in term of Kellgren-Law- rence grades for knee degeneration in both groups until the latest follow-up (P＞0.05) . [Conclusion] Both SA and CS fixation do effectively treat ACL tibial avulsion fracture, by contrast, SA has the advantages of facilitating fracture healing and providing better early clinical out-comes over the CS.