中国组织工程研究

中国组织工程研究 ›› 2017, Vol. 21 ›› Issue (35): 5655-5660.doi: 10.3969/j.issn.2095-4344.2017.35.013

• 骨科植入物 orthopedic implant • 上一篇    下一篇

关节镜下极后高位入路空心螺钉固定与标准入路缝线固定修复后交叉韧带胫骨止点撕脱骨折

王新民，刘 飞，赵海霞，王 巍，王健全   

  1. 秦皇岛市第一医院骨科二病区，河北省秦皇岛市 066000
  • 出版日期:2017-12-18 发布日期:2018-01-02
  • 通讯作者: 刘飞，教授，硕士研究生导师，秦皇岛第一医院关节外科，河北省秦皇岛市 066000
  • 作者简介:王新民，男，1981年生，河北省海港区人，汉族，2008年河北医科大学毕业，硕士，主治医师，主要从事关节外科的研究。
  • 基金资助:

    2017年度河北省医学科学研究重点课题计划

Arthroscopic treatment with canulated screw fixation through very high-posteromedial portal approach versus double bundle suture fixation for avulsion fracture of tibial attachment of posterior cruciate ligament

Wang Xin-min, Liu Fei, Zhao Hai-xia, Wang Wei, Wang Jian-quan   

  1. Orthopedics and Arthroscopic Ward Two, First Hospital of Qinhuangdao, Qinhuangdao 066000, Hebei Province, China
  • Online:2017-12-18 Published:2018-01-02
  • Contact: Liu Fei, Professor, Master’s supervisor, Orthopedics and Arthroscopic Ward Two, First Hospital of Qinhuangdao, Qinhuangdao 066000, Hebei Province, China
  • About author:Wang Xin-min, Master, Attending physician, Orthopedics and Arthroscopic Ward Two, First Hospital of Qinhuangdao, Qinhuangdao 066000, Hebei Province, China
  • Supported by:

    the Key Project Plan of Medical Science Research in Hebei Province in 2017

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摘要：

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文题释义：

关节镜下极后高位入路空心螺钉固定：改良设计关节镜下极后高位入路置钉手术技术直接进行骨折块复位内固定，对骨折块直接垂直加压，避免将骨折块拧碎，骨折固定稳定可靠，手术入路简单并微创。

关节镜下标准入路缝线固定：采用关节镜下标准后内入路双股缝线固定手术技术，对骨折块进行双股高强缝线捆绑固定，优点为不需要二次手术取出内固定物，对一些骨折块较碎的患者更有优势，但手术技术复杂，固定强度有待于随访观察。
 
摘要
背景：课题组改良设计了关节镜下极后高位入路置钉手术技术直接进行骨折块复位内固定，目的是可以对骨折块直接进行垂直加压，使骨折块所受压力均匀分布在愈合线上，且手术操作方便，固定牢固，但其临床疗效还有待进一步证实。
目的：比较关节镜下极后高位入路空心螺钉固定与标准入路缝线固定治疗后交叉韧带胫骨止点撕脱骨折的临床疗效。
方法：纳入2011年1月至2017年5月在秦皇岛市第一医院骨科二病区收治的60例急性后交叉韧带胫骨止点撕脱骨折患者(骨折块横径>10 mm)，根据不同时期手术方式不同分为2组：空心钉组(n=31)，采用关节镜下极后高位空心螺钉固定；缝线组(n=29)，采用关节镜下标准后内入路双股缝线内固定。比较2组患者的一般情况；术后随访分别采用国际膝关节文献委员会膝关节评估表(IKDC)和Lysholm评分进行主观膝关节功能评价；应用KT-2000及后抽屉试验客观评估膝关节稳定性。
结果与结论：①所有患者术程顺利并获得随访，随访时间为6-12个月；②空心钉组平均手术时间为(63.49±3.97) min，缝线组平均手术时间为(87.28±3.46) min，差异有显著性意义(P < 0.05)。术后3个月，所有患者骨折均愈合；③末次随访时空心钉组患者后抽屉试验阴性率为90%，Lysholm评分为94.89±4.75，IKDC评分为94.01±3.25；缝线组患者后抽屉试验试验阴性率为90%，Lysholm评分为95.56±3.63，IKDC评分为95.52±4.72，2组间比较均无明显差异(P > 0.05)；④KT-2000测量末次随访屈膝90°时患膝与健膝胫骨后向松弛度差异：空心钉组患膝(2.53±1.02) mm，健膝(2.12±0.83) mm；缝线组患膝为(2.65±0.82) mm，健膝为(2.19±0.63) mm，2组患者患膝与健膝之间比较无明显差异(P > 0.05)；且2组间患膝KT-2000比较无明显差异；⑤关节镜下极后高位入路置钉与缝线固定治疗后交叉韧带胫骨止点撕脱骨折均可以获得满意疗效；对于后交叉韧带胫骨止点撕脱骨折块直径>10 mm的患者，极后高位入路置钉手术时间更短，且骨折固定可靠，能保证患者早期进行膝关节功能锻炼。

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程
ORCID: 0000-0002-7867-2224(王新民)

关键词: 骨科植入物, 关节植入物, 关节镜, 极后高位入路, 空心螺钉固定, 缝线固定, 后交叉韧带, 撕脱骨折, KT-2000, 后抽屉试验, Lysholm评分, IKDC评分

Abstract:

BACKGROUND: This team modified the arthroscopic reduction and internal fixation with canulated screw through very high-posteromedial portal approach to perform direct compression. Thus, the pressure of the fracture block is evenly distributed on the healing line, and the operation is convenient and fixed firmly, but its clinical effect remains to be further confirmed.

OBJECTIVE: To compare the clinical outcome of arthroscopic reduction and internal fixation with canulated screw through very high-posteromedial portal approach and double bundle suture fixation for avulsion fracture of the tibial attachment of posterior cruciate ligament.
METHODS: From January 2011 to May 2017, 60 cases of the avulsion fracture of posterior cruciate ligament (transverse diameter of fracture block > 10 mm) were treated operatively at the Orthopedics and Arthroscopic Ward Two, First Hospital of Qinhuangdao, China. According to different modes of operation in different periods, patients were assigned to two groups. In the canulated screw group (n=31), patients were treated with canulated screw through very high- posteromedial portal approach. In the suture group (n=29), patients were treated with double bundle suture fixation through posteromedial portal approach. General conditions were compared between the two groups. Knee function was assessed with the Intemational Knee Documentation Committee and Lysholm scores. Knee stability was evaluated with KT-2000 and posterior drawer test.
RESULTS AND CONCLUSION: (1) All the patients were followed up (range 6-12 months). (2) The average operation time was (63.49±3.97) minutes in the canulated screw group and (87.28±3.46) minutes in the suture group (P < 0.05). At 3 months after surgery, all the patients were healed. (3) At the final follow-up, in the canulated screw group, the negative rate of posterior drawer test was 90%. Lysholm scores were 94.89±4.75. IKDC scores were 94.01±3.25. In the suture group, the negative rate of posterior drawer test was 90%. Lysholm scores were 95.56±3.63. IKDC scores were 95.52±4.72. No significant difference was determined between the two groups (P > 0.05). (4) KT-2000 measurement results revealed that there were no significant differences between the surgical knee and the normal knee in both groups (canulated screw group: (2.53±1.02) mm versus (2.12±0.83) mm; suture group: (2.65±0.82) mm versus (2.19±0.63) mm (P > 0.05). Moreover, no significant difference was detected in the affected knee of KT-2000 results between the two groups. (5) Both arthroscopic reduction with canulated screw through very high-posteromedial portal approach and double bundle suture fixation can achieve satisfactory clinical outcomes, but arthroscopic reduction with canulated screw through very high-posteromedial portal approach in patients with fracture block diameter > 10 mm can result in shorter operation time, more reliable fixation, and thus permit an early postoperative functional exercise.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Tibial Fractures, Posterior Cruciate Ligament, Arthroscopes, Tissue Engineering

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