后交叉韧带胫骨撕脱骨折两种固定的比较（开放获取）

Comparison of two fixation methods for posterior cruciate ligament tibial avulsion fracture

摘要:

[目的] 比较螺钉与双排锚钉缝线桥固定后交叉韧带胫骨止点骨折的临床疗效。[方法] 回顾性分析 2016 年 1 月— 2021 年 12 月在本院手术治疗的 72 例急性后交叉韧带胫骨止点骨折患者的临床资料。依据骨折情况，43 例采用切开复位松质骨螺钉垫圈固定（螺钉组），另外 29 例采用切开复位双排锚钉缝线桥固定（缝线桥组）。比较两组围手术期情况、随访及影像结果。[结果] 两组均顺利完成手术，均无神经、血管损伤等并发症。螺钉组手术时间显著少于缝线桥组 [(53.8±10.1) min vs (65.2±11.1) min, P＜0.05]，两组切口长度、术中透视次数、术后引流量、下地时间、切口愈合等级、住院时间的差异均无统计学意义 （P＞0.05）。随访时间平均 （12.6±2.9） 个月，两组恢复完全负重活动时间的差异无统计学意义 （P＞0.05）。术后随时间推移，两组 VAS、Lysholm 和 IKDC 评分，以及膝 ROM 和后抽屉试验均显著改善 （P＜0.05），相应时间点，两组间上述指标的差异均无统计学意义 （P＞0.05）。影像方面，对于骨折块横径＞10 mm 亚组，两组复位均为优，但对于骨折块横径≤10 mm 亚组， 缝线桥组骨折复位质量显著优于螺钉组 [优/良/差, (21/0/0) vs (13/2/2) , P＜0.05]。两组骨折愈合时间和 K-L 分级的差异均无统计学意义（P＞0.05）。[结论]螺钉和双排锚钉缝线桥固定后交叉韧带胫骨撕脱骨折均可取得较好的临床效果，但对于骨折块横径 ≤10 mm 或者粉碎性骨折，建议行双排锚钉缝线桥固定可取得更好的骨折固定效果。

Abstract:

[Objective] To compare the clinical efficacy of screw and washer versus double-row anchor suture bridge for open reduction and internal fixation (ORIF) of posterior cruciate ligament tibial avulsion fracture. [Methods] A retrospective study was conducted on 72 patients who received ORIF for acute posterior cruciate ligament tibial avulsion fractures in our hospital from January 2016 to December 2021. According to the fracture conditions, 43 patients had fracture fixed by screw and washer (the screw group), while the remaining 29 patients were fixed by double-row anchor suture bridge (the suture bridge group). The perioperative conditions, follow-up and imaging documents were compared between the two groups. [Results] All patients in both groups were operated on successfully with no serious complications, such as nerve and vascular injury. The screw group was significantly less than that of suture bridge group regarding operation time [(53.8±10.1) min vs (65.2±11.1) min, P＜0.05], although there were no statistically significant differences in incision length, intraoperative fluoroscopy times, postoperative drainage volume, ambulation time, incision healing grade, and hospital stay between the two groups (P＞ 0.05). The mean follow-up time was (12.6±2.9) months, and there was no significant difference between the two groups in the time to return to full weight-bearing activities (P＞0.05). The VAS, Lysholm and IKDC scores, as well as knee ROM and posterior drawer tests were significantly improved in both groups over time after surgery (P＜0.05), which were not statistically significant between the two groups at any time points accordingly (P＞0.05). Radiographically, the fracture with fragment diameter ＞ 10 mm all got proper reduction, but in those with the fragment diameter ≤10 mm, the suture bridge group was significantly better than the screw group in term of reduction quality [excellent/ good/poor, (21/0/0) vs (13/2/2), P＜0.05]. However, there were no statistically significant differences in fracture healing time and K-L grading accordingly between the two groups (P＞0.05). [Conclusion] Both screw-washer and double-row anchor suture bridge fixation for posterior cruciate ligament tibial avulsion fracture do achieve better clinical outcomes. However, for fracture with fragment diameter ≤10 mm or comminuted fracture, the double-row anchor suture bridge fixation might be the better selection.