自制双骨道导向器后交叉韧带撕脱骨折复位固定

Reduction and fixation of posterior cruciate ligament tibial avulsion fracture with a self-developed double-tunnel guider

摘要:

［目的］介绍在自制双骨道导向器镜下后交叉韧带（posterior cruciate ligament, PCL）撕脱骨折复位固定的手术技术和初步临床效果。［方法］ 2014 年 1 月— 2020 年 12 月使用自制双骨道导向器治疗 PCL 撕脱骨折患者 32 例。镜下清创后，由前内入口将双骨道定位器置入后室，定位器头端压于骨折块，复位骨折，尾端于胫骨前内侧分别置入 2 个导向管，打入克氏针， 分别建立骨折块旁 2 个骨道，维持骨折复位，先后取出 2 枚克氏针，用硬膜外套管针在镜下导入 2 根高强度爱惜邦缝线交叉捆扎骨折块，并经骨道拉出至胫骨结节内侧，结节处拉紧打结固定。［结果］32 例患者均在关节镜下顺利完成手术，建立 2 个骨道时间为（3.6±0.4）min，无神经、血管损伤等并发症。随访 12~18 个月，Lysholm 评分由术前的（28.7±7.8）分显著增加至末次随访的（94.0±2.4）分（P<0.001）。至末次随访，所有患者膝关节稳定，屈伸活动正常，后抽屉试验均为阴性，X 线片及 CT 复查骨折愈合良好。［结论］ 对后交叉韧带胫骨止点撕脱骨折镜下自制双骨道导向器可一次建立 2 个骨道，精准率高，显著提高操作效率。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical results of reduction and fixation of posterior cruci- ate ligament (PCL) tibial avulsion fractures under arthroscope with a self-developed double-tunnel guider. [Methods] From January 2014 to December 2020, 32 patients with PCL avulsion fracture were reduced and fixed arthroscopically with the self-developed double-tunnel guider. After arthroscopic debridement, the top part of double-tunnel guider was inserted into the posterior compartment through the antero- medial portal, pressed on the fracture block to reduce and fix it temporarily. Two guide tubes were placed on distal end of the guider on the anteromedial tibia, and then two Kirschner wires were inserted following the guide tubes to establish two bone tunnels adjacent to the frac- ture block. Maintaining fracture reduction, the 2 Kirschner wires were removed, and then two-bundle high-strength Ethicon sutures were in- troduced by epidural needles under the arthroscope to cross fracture block, which were pulled out through the bone tunnels to the anteromedi- al tibial, then tightened and fixed. [Results] All 32 patients had the arthroscopic procedures performed successfully with time to establish two bone tunnels of (3.6±0.4) min, whereas without neurovascular injury and other complications. Lysholm score increased significantly from (28.7±7.8) preoperatively to (94.0±2.4) at latest follow-up (P＜0.001) . At the latest follow-up, all patients got the stable knee with normal flexion-extension range of motion, while negative posterior drawer test, and good fracture healing by X-ray film and CT examination. [Conclusion]For arthroscopic reduction and fixation of PCL tibial avulsion fractures, this self-developed double-tunnel guider allows establish- ing two bone tunnels at a time with high precision, and significantly improve the operation efficiency.