后交叉韧带胫骨撕脱骨折线袢缝合两种外口固定比较△

Comparison of two kinds of outlet fixation of loop suture for posterior cruciate ligament tibial avulsion fracture

摘要:

[目的] 比较扣板与垫圈桩螺钉线袢固定膝关节后交叉韧带（posterior cruciate ligament, PCL） 胫骨止点撕脱骨折的临床疗效。[方法] 回顾性分析2020 年9 月—2023 年3 月在本院行关节镜下线袢固定膝关节PCL 胫骨止点撕脱骨折折43 例患者的临床资料。根据医患沟通结果，21 例采用胫骨隧道前口扣板固定，另外22 例采用垫圈桩螺钉固定。比较两组围手术期情况、随访资料和影像资料。[结果] 扣板组的手术时间显著少于螺钉组[(51.0±5.2) min vs (58.4±5.2) min, P＜0.001]，但两组在切口总长度、术中失血量、下地行走时间、住院时间的差异均无统计学意义（P＞0.05）。所有患者均获随访12 个月以上，平均（20.2±4.6） 个月，两组完全负重活动时间差异无统计学意义（P＞0.05）。随着术后时间的推移，两组Lysholm 评分、IKDC 评分均显著增加（P＜0.05），而后抽屉试验等级显著减少（P＜0.05）。术前、术后3 个月和末次随访，两组Lysholm 评分、IKDC 评分和后抽屉试验差异均无统计学意义（P＞0.05）。影像方面，两组骨折复位质量，骨折愈合时间的差异均无统计学意义（P＞0.05）。[结论] 关节镜下线袢固定PCL 胫骨止点撕脱骨折，使用扣板和垫圈桩螺钉固定均能获得良好的临床效果，但前者手术时间更少。

Abstract:

[Objective] To compare the clinical outcomes of suture loop with button plate (BP) versus post washer screw (PWS) outletfixations for posterior cruciate ligament (PCL) tibial avulsion fractures. [Methods] A retrospective study was performed on 43 patients whoreceived arthroscopic suture loop fixation of PCL tibial avulsion fractures in our hospital from September 2020 to March 2023. According tothe results of doctor-patient communication, 21 patients had the suture loop fixed by BP at the anterior outlet of the tibial tunnel, while theother 22 patients were fixed by PWS. The perioperative conditions, follow-up data and imaging data were compared between the twogroups. [Results] The BP group consumed significantly less operative time than the PWS group [(51.0±5.2) min vs (58.4±5.2) min, P＜0.001], however, there were no significant differences in the total incision length, intraoperative blood loss, postoperative walking time andhospital stay between the two groups (P＞0.05). All patients in both groups were followed up for more than 12 months, with an average of(20.2±4.6) months, and there was no significant difference in the time to resume full weight-bearing activities between the two groups (P＞0.05). With the passage of postoperative time, Lysholm score and IKDC score were significantly increased in both groups (P＜0.05), whilethe posterior drawer test grade was significantly declined (P＜0.05). There were no significant differences in Lysholm score, IKDC score andpost-drawer test between the two groups before surgery, 3 months after surgery and the last follow-up (P＞0.05). In terms of imaging, therewere no significant differences in fracture reduction quality and fracture healing time between the two groups (P＞0.05). [Conclusion] In ar-throscopic suture loop fixation of PCL tibial avulsion fractures, both BP and PWS fastenings at the anterior outlet do obtain good clinicalconsequences, but the former consumed operation time considerably less.