联合空心钉、接骨板及不可吸收缝线治疗后十字韧带胫骨撕脱骨折的临床疗效

摘要

目的 探讨联合空心钉、锁定加压接骨板(locking compression plate,LCP)及不可吸收缝线悬吊三种内固定方式治疗后十字韧带(posterior cruciate ligament,PCL)胫骨撕脱骨折的临床疗效.方法回顾性分析2012年11月～2017年8月在我科联合三种内固定手术治疗的17例PCL胫骨撕脱骨折患者的临床资料,均经腘窝倒"L"入路切开复位,联合空心钉对骨折端加压、LCP接骨板对骨折进行三维固定、不可吸收缝线缝合套扎PCL悬吊于LCP接骨板上减少张力.所有患者手术前后均采用IKDC、Lysholm评分及X线评估.结果 本组手术时间90～120min,平均(103.2±11.0)min,出血量20～50ml.所有骨折移位均获得解剖复位.17例患者均获随访,平均14.4(6～24)个月.本组患者术后5～6周内膝关节屈曲和伸展恢复正常,术后8周内步态归于正常,术后12周随访复查X线证实骨愈合,未发生感染、血管神经损伤、骨折移位、内固定断裂、骨不愈合或延迟愈合并发症.末次随访时平均膝关节活动度为130°(110°～140°).16例患者下蹲正常,1例下蹲时感觉内固定阻挡不适于术后1年再次手术取出接骨板.末次随访IKDC系统评分由术前(13.6±5.8)分升至(85.4±12.1)分(A12例,B1例,C4例);Lysholm评分由术前(5.3±3.7)分升至(86.7±10.2)分(优5例,良7例,差5例);IKDC和Lysholm均较术前有统计学差异(P＜0.01).结论 经腘窝倒"L"入路切开,联合空心钉、锁定加压接骨板及不可吸收缝线悬吊治疗PCL胫骨撕脱骨折,其方法简单,临床疗效安全可靠;该手术无需特殊器械,适合各级医院开展.%Objective To investigate the clinical effect of internal fixation of cannulated screw, locking compression plate (LCP) and nonabsorbable suture suspension for posterior cruciate ligament (PCL) tibial avulsion fractures. Methods The clinical data of 17 cases with PCL tibial avulsion fractures in our department from November 2012 to August 2017 performed the surgery of open reduction combined with three internal fixation methods of compression with cannulated screw, LCP fixation and non-absorbable sutures suspension via an inverted L-shape popliteal incision were analyzed retrospectively. The IKDC score and Lysholm score were evaluated. Results The operative duration was 90 to 120 min with (103.2±11.0) min averagely, and the blood loss volume was 20 to 50 ml. All fracture displacement achieved anatomical reduction. All cases were followed up for 6 to 24 months with an average of 14. 4 months. The knee flexion and extension returned to normal within 5 to 6 weeks, the gait returned to normal within 8 weeks, and all fractures healed successfully within 12 weeks after the operation. No complications as infection, vascular nerve injury, fracture displacement, internal fixator broken, bone nonunion and delayed union were found. At the last follow-up, the average knee motion was 130° (110° ～ 140°). Sixteen patients squatted normally, while one patient felt uncomfortable due to internal fixation during squatting and removed the LCP at one year after the operation. The IKDC score increased from 13.6±5.8 to 85.4±12.1, and the Lysholm score from 5.3±3.7 to 86.7±10.2; Both IKDC and Lysholm scores improved significantly at the last follow-up than those before the operation (P＜0.01). Conclusion The three combined internal fixation methods of compression with cannulated screw, LCP fixation and non-absorbable sutures suspension via an inverted L-shape popliteal incision is safe, available and reliable for the tibial avulsion fractures, and suitable for all hospital without necessary of special instruments.