张力带钢板与空心钉固定后交叉韧带胫骨撕脱骨折比较（开放获取）

Tension band plate versus cannulated screw for fixation of posterior cruciate ligament tibial avulsion fractures

摘要:

[目的] 比较张力带钢板与空心钉固定后交叉韧带胫骨止点撕脱骨折的临床疗效。[方法] 回顾性分析 2018 年 1 月 —2024 年 6 月开放复位内固定治疗的 48 例后交叉韧带胫骨止点撕脱骨折患者的临床资料。依据术前医患沟通结果，23 例采用张力带钢板固定（钢板组），25 例采用空心钉固定（螺钉组）。比较两组患者临床和影像资料。[结果]术前一般资料比较，钢板组粉碎性骨折比率显著高于螺钉组 [例, 单块/粉碎, (6/17) vs (16/9), P=0.008]。两组患者手术均顺利完成，术中均无血管神经损伤等严重并发症。钢板组在手术时间 [min, (63.4±7.6) vs (53.7±7.2) , P=0.001]、切口长度 [cm, (7.5±0.9) vs (6.4±1.0), P=0.001]、术中出血量 [mL, (63.7±8.7) vs (56.7±7.6), P=0.005]、术后引流量 [mL, (76.5±14.7) vs (55.4±10.5), P=0.001] 均显著大于螺钉组。但是，钢板组术中增加锚钉使用率显著低于螺钉组 （4.4% vs 32.0%, P=0.037）。两组术后并发症发生率的差异无统计学意义 （P＞0.05）。 两组患者平均随访（12.5±2.8）个月。随访过程中，两组患者均未发生严重不良事件。末次随访时，两组患者在最大膝关节主动屈曲角度、膝关节伸直缺失角度和 Lysholm 膝关节功能评分的差异均无统计学意义 （P＞0.05）。影像方面，两组骨折复位质量优良率差异无统计学意义（P＞0.05），两组术后骨折块移位发生率差异无统计学意义（P＞0.05）。末次随访时，两组患者的骨折块均骨性愈合率，内固定物无松动，膝关节均无明显退行性变化。[结论]张力带钢板和空心钉固定治疗后交叉韧带胫骨止点撕脱骨折均可取得较好的临床效果。对于粉碎性撕脱骨折，使用张力带钢板固定更为合理。

Abstract:

[Objective] To compare the clinical efficacy of tension band plate versus cannulated screw for fixation of posterior cruciate ligament (PCL) tibial avulsion fractures. [Methods] A retrospective study was conducted on 48 patients who had PCL tibial avulsion fractures treated by open reduction and internal fixation (ORIF) from January 2018 to June 2024. According to preoperative doctor-patient communication, 23 patients had fractures fixed with tension band plate (the plate group), while other 25 patients were fixed with cannulated screw (the screw group). The clinical and imaging data of the two groups were compared. [Results] Regarding preoperative general data, the plate group had significantly higher rate of comminuted fracture than the screw group [single/comminuted, (6/17) vs (16/9), P=0.008]. All patients in both groups had ORIF performed smoothly without serious complications, such as vascular and nerve injury. The plate group proved significantly greater than the screw group in terms of operative time [min, (63.4±7.6) vs (53.7±7.2), P=0.001], incision length [cm, (7.5±0.9) vs (6.4±1.0), P=0.001], intraoperative blood loss [mL, (63.7±8.7) vs (56.7±7.6), P=0.005] and postoperative drainage [mL, (76.5± 14.7) vs (55.4±10.5), P=0.001], respectively. However, the former used significantly less additional anchors than the latter (4.4% vs 32.0%, P=0.037). There was no significant difference in the incidence of postoperative complications between the two groups (P＞0.05). All patients in both groups were followed up for an average of (12.5±2.8) months, and during the follow-up period, no serious adverse events occurred in either group. At the latest follow-up, there were no significant differences between the two groups in the maximum active knee flexion angle, knee extension loss angle and Lysholm score (P＞0.05). As for imaging, there was no a statistically significant difference in the rate of excellent and good fracture reduction between the two groups (P＞0.05), and no statistically significant difference in the incidence of fracture re-displacement between the two groups (P＞0.05). At the last follow-up, all patients in both groups got fractures healed well, without loosening of the internal fixation, and obvious degenerative changes of the knee. [Conclusion] Both tension band plate and cannulated screw fixation do achieve good clinical consequence in the treatment of PCL tibial avulsion fractures. For the comminuted avulsion fractures, the use of tension plate fixation is more reasonable.