无结锚钉与空心钉固定后交叉韧带胫骨撕脱骨折

Knotless anchor versus cannulated screw for fixation of posterior cruciate ligament tibial avulsion fractures

摘要:

[目的] 比较关节镜下无结锚钉与空心钉固定技术治疗后交叉韧带（posterior cruciate ligament, PCL） 胫骨止点撕脱骨折疗效。[方法] 回顾性分析2013 年10 月—2020 年10 月本院收治的急性PCL 胫骨止点撕脱性骨折28 例患者的临床资料，均实施关节镜下复位固定手术。根据医患沟通结果，14 例患者采用锚钉固定，另外14 例采用空心钉固定。比较两组围手术期、随访和影像资料。[结果] 所有患者均顺利完成手术，无严重并发症。两组在手术时间、手术切口大小、失血量、切口愈合等级和住院时间的差异均无统计学意义（P＞0.05）。锚钉组在术中透视[(0)次vs (2.1±0.4)次, P＜0.001] 和术后止痛药使用[(2.1±0.5)d vs (3.1±0.6) d, P＜0.001] 均显著优于空心钉组，但是前者医疗费用[(29 677.3±2 406.3) 元vs (18 605.2± 953.7) 元, P＜0.001] 显著高于后者。两组患者恢复完全负重的时间差异无统计学意义（P＞0.05）。与术后3 个月相比，末次随访时两组患者VAS、IKDC、Lysholm 评分和ROM 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，两组间骨折复位质量和骨折愈合时间的差异均无统计学意义（P＞0.05）。至末次随访时，两组患者均无明显膝关节退变加重的影像改变。[结论] 无结锚钉与空心钉固定技术治疗PCL 胫骨止点撕脱骨折均可获得良好的手术效果。相比之下，无结锚钉术后舒适度高，但治疗费用更高。

Abstract:

[Objective] To compare the clinical efficacy of arthroscopic knotless anchor versus cannulated screw for fixation of posteri-or cruciate ligament (PCL) tibial avulsion fractures. [Methods] A retrospective study was performed on 28 patients who received arthroscop-ic reduction and fixation of acute PCL tibial avulsion fractures in our hospital from October 2013 to October 2020. According to doctor-pa-tient communication, 14 patients had fractures fixed with knotless anchors, while the other 14 patients were with cannulated screws. Theperioperative, follow-up and imaging data were compared between the two groups. [Results] All patients were operated on smoothly withoutserious complications. There were no significant differences in operation time, incision length, blood loss, incision healing grade and hospi-tal stay between the two groups (P＞0.05). The anchor groups proved significantly superior to the screw group in terms of intraoperative fluo-roscopy [(0) times vs (2.1±0.4) times, P＜0.001] and postoperative analgesic use [(2.1±0.5) days vs (3.1±0.6) days, P＜0.001], despite of thefact that the former spent significantly higher medical cost than the latter [(29 677.3±2 406.3) yuan vs (18 605.2± 953.7) yuan, P＜0.001].There was no significant difference between the two groups in the time to regain full-weight bearing activity (P＞0.05). Compared with those3 months after surgery, the VAS, IKDC and Lysholm scores, as well as ROM significantly improved in both groups at the last follow-up (P＜0.05), which were not statistically significant between the two groups at any time points accordingly (P＞0.05). Regarding to imaging, therewere no statistically significant differences in fracture reduction quality and fracture healing time between the two groups (P＞0.05). At thelast follow-up, there was no significant imaging change of worsening knee degeneration in both groups. [Conclusion] Both knotless anchorand cannulated screw fixation do achieve good consequences for PCL tibial avulsion fractures. In contrast, the knotless anchor has higherpostoperative comfort but higher treatment costs.