關節鏡輔助下膝后內側切口治療急性后交叉韌帶脛骨止點撕脫骨折_《中國修復重建外科雜志》

作者：

劉金標 , 鄧冰 , 黃鋼 , 潘顯明 , 鄧少林 , 廖冬發 , 李偉

成都軍區總醫院骨科（成都，610083）;

關鍵詞：

后交叉韌帶脛骨止點撕脫骨折關節鏡內固定

DOI：

10.7507/1002-1892.20130130

視頻：

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目的探討關節鏡輔助下采用膝后內側切口治療急性后交叉韌帶（posterior cruciate ligament，PCL）脛骨止點撕脫骨折的方法及臨床療效。方法2010年1月－2012年1月，采用關節鏡輔助下膝后內側切口復位內固定治療22例急性PCL脛骨止點撕脫骨折患者。男14例，女8例；年齡18～48歲，平均32歲。致傷原因：交通事故傷14例，運動傷4例，摔傷4例。傷后至手術時間7～16 d，平均10 d。后抽屜試驗均為陽性。單純PCL損傷14例，合并半月板損傷6例，軟骨損傷2例。術前膝關節功能Lysholm評分為（51.1 ± 3.4）分。結果術后切口均Ⅰ期愈合，無感染、下肢深靜脈血栓形成、神經損傷等并發癥發生。22例均獲隨訪，隨訪時間12～24個月，平均18.4個月。X線片復查示骨折均達骨性愈合，愈合時間2～4個月，平均3個月。術后6個月5例后抽屜試驗為陽性，余均為陰性。術后6個月Lysholm評分為（96.0 ± 2.2）分，與術前比較差異有統計學意義（t=43.020，P=0.000）。結論關節鏡輔助下膝后內側切口復位內固定治療急性PCL脛骨止點撕脫骨折是一種創傷小、操作安全、方法簡便、療效確實的方法。

引用本文： 劉金標,鄧冰,黃鋼,潘顯明,鄧少林,廖冬發,李偉. 關節鏡輔助下膝后內側切口治療急性后交叉韌帶脛骨止點撕脫骨折. 中國修復重建外科雜志, 2013, 27(5): 591-593. doi: 10.7507/1002-1892.20130130 復制

1.	Lyscholm J, Gillguist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sport Med, 1982, 10(3): 150-154.
2.	朱新輝, 劉巍, 嚴建軍, 等. 交叉韌帶止點骨折的微創手術治療. 中國骨與關節損傷雜志, 2011, 26(7): 629-630.
3.	Zhang H, Hong L, Wang XS, et al. All-arthroscopic repair of acute avulsion fracture with suture anchor. Arthroscopy, 2011, 27(5): 728-734.
4.	Xu Z, Chen D, Shi D, et al. Case report: Osteochondral avulsion fracture of the posteromedial bundle of the PCL in knee hyperflexion. Clin Orthop Relat Res, 2012, 470(12): 3616-3623.
5.	Wajsfisz A, Makridis KG, Van Den Steene JY, et al. Fixation of posterior cruciate ligament avulsion fracture with the use of a suspensory fixation. Knee Surg Sports Traumatol Arthrosc, 2012, 20(5): 996-999.
6.	Sasaki SU, da Mota e Albupuerque RF, Amatuzzi MM, et al. Open screw fixation versus arthroscopic suture fixation of tibial posterior cruciate ligament avulsion injuries: a mechanical comparison. Arthroscopy, 2007, 23(11): 1226-1230.
7.	Gui J, Wang L, Jiang Y, et al. Single-tunnel suture fixation of posterior cruciate ligament avulsion fracture. Arthroscopy, 2009, 25(1): 78-85.
8.	Horas U, Meissner SA, Heiss C, et al. Arthroscopic fixation of posterior cruciate ligament avulsion fractures: a new minimally invasive technique. Knee Surg Sports Traumatol Arthrosc, 2010, 18(6): 781-783.
9.	Yang CK, Wu CD, Chih CJ, et al. Surgical treatment of avulsion fracture of the posterior cruciate ligament and postoperative management. J Trauma Mar, 2003, 54(3): 516-519.
10.	Zhang X, Cai G, Wang K. A minimally invasive postero-medial approach with suture anchors for isolated tibial avulsion fracture of the posterior cruciate ligament. Knee, 2013, 20(2): 96-99.
11.	Jazayeri SM, Esmaili Jah AA, Karami M. A safe postero-medial approach to posterior cruciate ligament avulsion fracture. Knee Surg Sports Traumatol Arthrosc, 2009, 17(3): 244-247.
12.	繆國平, 張弛, 王俊, 等. 小切口入路空心螺釘和縫線錨釘治療后交叉韌帶脛骨止點撕脫骨折的比較. 中國骨與關節外科, 2012, 5(3): 255-257.
13.	Frosch K, Proksch N, Preiss A, et al. Treatment of bony avulsions of the posterior cruciate ligament (PCL) by a minimally invasive dorsal approach. Oper Orthop Traumatol, 2012, 24(4-5): 348-353.
14.	Chen W, Tang D, Kang L. Effects of microendoscopy-assisted reduction and screw fixation through a single mini-incision on posterior cruciate ligament tibial avulsion fracture. Arch Orthop Trauma Surg, 2012, 132(4): 429-435.
15.	Bali K, Prabhakar S, Saini U, et al. Open reduction and internal fixation of isolated PCL fossa avulsion fractures. Knee Surg Sports Traumatol Arthrosc, 2012, 20(2): 315-321.
16.	Chen SY, Cheng CY, Chang SS, et al. Arthroscopic suture fixation for avulsion fractures in the tibial attachment of the posterior cruciate ligament. Arthroscopy, 2012, 28(10): 1454-1463.
17.	狄正林, 徐榮明, 馮建翔, 等. 膝關節后側有限切開不吸收縫線內固定治療后交叉韌帶脛骨止點骨折. 中國骨與關節損傷雜志, 2005, 20(4): 283-284.
18.	譚海濤, 江建中, 楊克勤, 等. 關節鏡引導下錨釘縫線治療后交叉韌帶脛骨止點骨折. 微創醫學, 2010, 5(1): 8-10.

1. Lyscholm J, Gillguist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sport Med, 1982, 10(3): 150-154.
2. 朱新輝, 劉巍, 嚴建軍, 等. 交叉韌帶止點骨折的微創手術治療. 中國骨與關節損傷雜志, 2011, 26(7): 629-630.
3. Zhang H, Hong L, Wang XS, et al. All-arthroscopic repair of acute avulsion fracture with suture anchor. Arthroscopy, 2011, 27(5): 728-734.
4. Xu Z, Chen D, Shi D, et al. Case report: Osteochondral avulsion fracture of the posteromedial bundle of the PCL in knee hyperflexion. Clin Orthop Relat Res, 2012, 470(12): 3616-3623.
5. Wajsfisz A, Makridis KG, Van Den Steene JY, et al. Fixation of posterior cruciate ligament avulsion fracture with the use of a suspensory fixation. Knee Surg Sports Traumatol Arthrosc, 2012, 20(5): 996-999.
6. Sasaki SU, da Mota e Albupuerque RF, Amatuzzi MM, et al. Open screw fixation versus arthroscopic suture fixation of tibial posterior cruciate ligament avulsion injuries: a mechanical comparison. Arthroscopy, 2007, 23(11): 1226-1230.
7. Gui J, Wang L, Jiang Y, et al. Single-tunnel suture fixation of posterior cruciate ligament avulsion fracture. Arthroscopy, 2009, 25(1): 78-85.
8. Horas U, Meissner SA, Heiss C, et al. Arthroscopic fixation of posterior cruciate ligament avulsion fractures: a new minimally invasive technique. Knee Surg Sports Traumatol Arthrosc, 2010, 18(6): 781-783.
9. Yang CK, Wu CD, Chih CJ, et al. Surgical treatment of avulsion fracture of the posterior cruciate ligament and postoperative management. J Trauma Mar, 2003, 54(3): 516-519.
10. Zhang X, Cai G, Wang K. A minimally invasive postero-medial approach with suture anchors for isolated tibial avulsion fracture of the posterior cruciate ligament. Knee, 2013, 20(2): 96-99.
11. Jazayeri SM, Esmaili Jah AA, Karami M. A safe postero-medial approach to posterior cruciate ligament avulsion fracture. Knee Surg Sports Traumatol Arthrosc, 2009, 17(3): 244-247.
12. 繆國平, 張弛, 王俊, 等. 小切口入路空心螺釘和縫線錨釘治療后交叉韌帶脛骨止點撕脫骨折的比較. 中國骨與關節外科, 2012, 5(3): 255-257.
13. Frosch K, Proksch N, Preiss A, et al. Treatment of bony avulsions of the posterior cruciate ligament (PCL) by a minimally invasive dorsal approach. Oper Orthop Traumatol, 2012, 24(4-5): 348-353.
14. Chen W, Tang D, Kang L. Effects of microendoscopy-assisted reduction and screw fixation through a single mini-incision on posterior cruciate ligament tibial avulsion fracture. Arch Orthop Trauma Surg, 2012, 132(4): 429-435.
15. Bali K, Prabhakar S, Saini U, et al. Open reduction and internal fixation of isolated PCL fossa avulsion fractures. Knee Surg Sports Traumatol Arthrosc, 2012, 20(2): 315-321.
16. Chen SY, Cheng CY, Chang SS, et al. Arthroscopic suture fixation for avulsion fractures in the tibial attachment of the posterior cruciate ligament. Arthroscopy, 2012, 28(10): 1454-1463.
17. 狄正林, 徐榮明, 馮建翔, 等. 膝關節后側有限切開不吸收縫線內固定治療后交叉韌帶脛骨止點骨折. 中國骨與關節損傷雜志, 2005, 20(4): 283-284.
18. 譚海濤, 江建中, 楊克勤, 等. 關節鏡引導下錨釘縫線治療后交叉韌帶脛骨止點骨折. 微創醫學, 2010, 5(1): 8-10.

《中國修復重建外科雜志》

關節鏡輔助下膝后內側切口治療急性后交叉韌帶脛骨止點撕脫骨折

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《中國修復重建外科雜志》

關節鏡輔助下膝后內側切口治療急性后交叉韌帶脛骨止點撕脫骨折

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