镜下一期治疗前交叉韧带断裂合并胫骨后外侧平台骨折△（开放获取）

Arthroscopic repair of anterior cruciate ligament injury combined with posterolateral tibial plateau fracture

摘要:

[目的] 介绍镜下一期治疗前交叉韧带断裂合并胫骨后外侧平台骨折的手术技术和初步临床结果。[方法] 2019 年 1 月—2021 年 7 月，53 例前交叉韧带损伤合并胫骨平台后外侧压缩骨折的患者通过 MRI 检查结果分型，依照分型行关节镜下前交叉韧带重建及胫骨平台骨折复位术。取自体腘绳肌腱制备前交叉韧带移植物后建立股骨隧道和胫骨隧道，行前交叉韧带重建术。关节镜直视下使用前交叉韧带重建胫骨定位导向器定位骨折塌陷部位，建立胫骨隧道，注意避开 ACL 重建的胫骨隧道，置入同侧髂骨填充，关节镜下见骨折塌陷复位良好。[结果]53 例患者均顺利完成手术。手术时间平均 （58.3±33.7）min， 随访时间平均 （14.3±2.8） 个月， VAS 评分由术前的 （6.7±1.5） 分显著降低至末次随访时的 （1.3±0.7） 分 （P＜0.001）；IKDC 膝关节评分由术前的（52.6±6.3）分显著增加至末次随访时的（87.5±7.2）分（P＜0.001）。膝关节屈伸活动及轴移较术前显著改善（P＜0.05）。患者骨折均愈合，前交叉韧带均愈合良好。[结论]关节镜下一期行后外侧胫骨平台压缩骨折复位及前交叉韧带修复的方法简单有效，早期临床效果满意。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical consequence of concurrent arthroscopic anterior cruciate ligament (ACL) reconstruction and posterolateral lateral tibial plateau fracture reduction. [Methods] From January 2019 to July 2021, 53 patients received abovesaid arthroscopic procedures for ACL tear complicated with posterolateral tibial plateau impacted fractures. Based on preoperative MRI classification, the arthroscopic ACL reconstruction and tibial plateau fracture reduction were performed. After the hamstring tendons were harvested to prepare a quadruple tendon graft, the femoral tunnel was established through the inferomedial portal, then ACL tibial tunnel was established, and the remaining ACL reconstruction procedure was finished in routine manner. Under the arthroscopy, the anterior cruciate ligament reconstruction tibial guide was located the collapsed fracture site, and the tibial tunnel was created to the subchondral bone with caution to avoid interference of previous tibial tunnel for ACL reconstruction. As proper articular surface reduction was observed under arthroscopy, bone autografts harvest from the ipsilateral ilium were filled and impacted into the bone tunnel to support and fixed the fracture. [Results] All the 53 patients had operation performed successfully without complications, whereas with the average operation time of (58.3±33.7) min, and were followed up for (14.3±2.8) months. All patients had the posterolateral tibial plateau fractures and reconstructed ACL healed well, with VAS score [(6.7±1.5), (1.3±0.7), P＜0.001], IKDC score [(52.6±6.3), (87.5±7.2), P＜0.001], as well as knee range of motion (ROM) and pivot shift phenomena improved significantly at the latest follow-up compared with those before surgery (P＜0.05). [Conclusion] The simultaneous arthroscopic posterolateral tibial plateau fracture reductionfixation and ACL reconstruction are simple and feasible techniques to treat the combined knee injury, do achieve satisfactory short-term clinical outcome.