经Burks和SchaVer入路带线铆钉缝合固定治疗膝关节后交叉韧带胫骨止点撕脱骨折的效果观察

Effect observation of suture and fixation with sutured rivets in treating avulsion fracture of tibial insertion of posterior cruciate ligament of knee joint through Burks and SchaVer approach

  • 摘要: 目的 观察经Burks和SchaVer入路带线铆钉缝合固定治疗膝关节后交叉韧带(PCL)胫骨止点撕脱骨折的疗效。 方法 回顾性分析2016年6月—2017年6月南华大学附属第二医院收治的13例(13膝)膝关节PCL胫骨止点撕脱骨折患者的临床资料。评估手术后膝关节疼痛及肿胀情况、后抽屉试验结果及膝关节活动度。记录手术前后患者的Lysholm膝关节功能评分和国际膝关节文献委员会(IKDC)膝关节功能主观评分。 结果 术中显露后均可见骨折块移位超过10.0 mm, 骨折块厚度较薄,且多为粉碎性。13例患者平均随访时间为8.8个月,平均手术时间为49.5 min, 术后平均愈合时间为9.8周,术后膝关节不稳症状均消失,后抽屉试验和胫骨后沉征均为阴性。末次随访时,膝关节平均屈伸活动度为113 °。IKDC膝关节主观评分为(86.1±2.3)分,与术前(52.1±2.3)分比较差异有统计学意义(P<0.05),膝关节Lysholm评分为(89.6±2.1)分,与术前(40.1±3.2)分比较差异有统计学意义(P<0.05)。术后发生切口愈合不良1例,经换药3周及抗感染治疗后愈合。 结论 经Burks和SchaVer入路带线铆钉缝合固定安全、有效,不需要显露血管神经,术中解剖复位效果满意,固定牢靠。

     

    Abstract: Objective To observe the effect of suture and fixation with sutured rivets in treating avulsion fracture of tibial insertion of posterior cruciate ligament(PCL)of knee joint through Burks and SchaVer approach. Methods The clinical materials of 13 patients(13 knees)with avulsion fracture of tibial insertion of PCL of knee joint in the Second Affiliated Hospital of Nanhua University from June 2016 to June 2017 were retrospectively analyzed. The pain and swelling of knee joint, the results of back drawer test and the range of motion of knee joint were evaluated. The score of Lysholm knee function and score of subjective knee function of International Knee Document Committee(IKDC)were evaluated before and after operation. Results After exposure during the operation, the displacement of fracture blocks was more than 10.0 mm, the thickness of fracture blocks was thin, and most of them were comminuted. The average follow-up time of 13 patients was 8.8 months, the average operation time was 49.5 minutes, and the average healing time was 9.8 weeks. The instability symptoms of knee joint disappeared after operation, and the posterior drawer test and tibial sinkage sign were negative. At the last follow-up, the average range of motion of knee joint was 113 degrees. the score of subjective knee function of IKDC was(86.1±2.3)points, which showed significant difference - cohen compared to(52.1±2.3)points before operation(P<0.05). Score of Lysholm was(89.6±2.1)points after operation, which was significantly higher than(40.1±3.2)points before operation(P<0.05). There was one case with poor healing of incision, and the patient was cured after 3 weeks of dressing change and anti-infection treatment. Conclusion Suture and fixation with sutured rivets through Burks and SchaVer approach is effective and safe, which is no need to expose blood vessels and nerves, and anatomical reduction effect is satisfactory and fixation is reliable.

     

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