关节镜下三重固定后交叉韧带胫骨止点撕脱骨折△（开放获取）

Arthroscopic triple fixations of posterior cruciate ligament tibial avulsion fracture

摘要:

[目的]介绍关节镜下三重固定治疗后交叉韧带胫骨止点撕脱骨折的手术技术和初步临床结果。[方法]2022 年 1 月— 2023 年 1 月收治 18 例膝关节后交叉韧带胫骨止点撕脱骨折患者，建立膝关节前内、前外和后内侧入口，清理骨折端；用后交叉韧带重建定位器复位骨折块，建立骨隧道。抓取 2 根高强线，穿部分后交叉韧带至后关节腔环绕后交叉韧带形成“肚袋环”，并将高强线尾端，双扣板线袢导入骨隧道，拉紧高强线尾端，辅助骨块复位，锁紧双扣板线袢固定，并将高强度线与双扣板线袢系统打结固定。最后，将双扣板线袢辅助后侧牵引线围绕 PCL，经骨隧道引至前侧，收紧打结固定。镜下依次完成高强线套环、双扣板线袢和辅助线的三重固定。[结果]所有患者均顺利完成手术，手术时间平均（67.0±22.5）min。随访时间平均（12.5±2.7）个月。与术前相比，术后 3 个月疼痛 VAS 评分显著下降 [(5.8±1.4), (0.7±0.6), P＜0.001]。与术前相比，术后 12 个月 HSS 评分 [(46.4± 9.8), (94.8±3.8), P＜0.001] 和 Lysholm 评分 [(49.4±9.5), (93.4±4.1), P＜0.001] 显著增加。至术后 3 个月，X 线片显示所有患者骨折均愈合。[结论]关节镜下三重固定治疗后交叉韧带胫骨止点撕脱骨折安全可靠、微创，提供稳定可靠骨折愈合条件。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical outcome of arthroscopic triple fixation for posterior cruciate ligament (PCL) tibial avulsion fracture. [Methods] From January 2022 to January 2023, 18 patients received abovementioned surgical treatment for PCL tibial avulsion fracture. After anterolateral, anteromedial and posteromedial portals were created, the intraarticular exploration and debridement were conducted. As the fracture fragment was reduced with PCL tibial guider, a bone tunnel was established anteroposteriorly through the fracture fragment. Grabing 2 high-strength sutures into the joint, passing through and around the PCL to form a "pocket ring", and introducing ends of the high-strength suture and double-button loop sutures into the bone tunnel to tibial front side, tighten the tail end of the high-strength suture to assist the bone fragment reduction, tightening the double-button loop to until the both buttons firmly seated on the bone to fix the fracture fragment, and tied the high strength suture with the button loops suture. Finally, the assisted traction suture of button-loop system on the posterior side was passed around the PCL, and then lead to the front side through the bone tunnel, tightened and knotted to accomplish the triple fixation with the high-strength suture, double-button loop and auxiliary wire in sequence under arthroscope. [Results] All patients had operation performed successfully with operation time of (67.0±22.5) min, and followed up for (12.5±2.7) months. Compared with that preoperatively, the pain VAS score was declined significantly 3 months and postoperatively [(5.8±1.4), (0.7±0.6), P＜0.001]. In addition, compared with those preoperatively, the HSS score [(46.4±9.8), (94.8±3.8), P＜0.001] and Lysholm score [(49.4±9.5), (93.4±4.1), P＜0.001] increased significantly 12 months after operation. All patients got fractures healed well on X ray by 3 months postoperatively. [Conclusion] This arthroscopic triple fixation for PCL tibial avulsion fracture is a safe, reliable and minimally invasive technique, providing stable and reliable fracture healing conditions.