经关节镜下胫骨双隧道双ET...带胫骨止点撕脱骨折疗效观察_叶武智.pdf

Hainan Med J,Apr.2023,Vol.34,No.8海南医学2023年4月第34卷第8期经关节镜下胫骨双隧道双ETHIBOND线联合Versalok锚钉内固定治疗后交叉韧带胫骨止点撕脱骨折疗效观察叶武智，张树峰，高长城榆林市中医医院骨伤三科，陕西榆林719000【摘要】目的观察经关节镜下胫骨双隧道双ETHIBOND线联合Versalok 锚钉内固定治疗后交叉 韧带(PCL)胫骨止点撕脱骨折的疗效。方法回顾性分析2019年8月至2021年8月榆林市中医医院骨伤三科收治的80例后交叉韧带胫骨止点撕脱骨折患者的临床诊治资料，根据不同的手术方案分为双ETHIBOND线组(41例，采用经关节镜下胫骨双隧道双 ETHIBOND 线固定治疗)和联合 Versalok 锚钉组(39 例，在对照组的基础上联合Versalok锚钉内固定)。比较两组患者的手术时间、住院时间、术后骨折复位情况、骨折愈合时间及膝关节活动功能变化，并记录两组患者术后并发症发生情况。结果联合Versalok锚钉组患者的骨折愈合时间为(72.399.68)d，短于双ETHIBOND线组的(84.1210.36)d，差异有统计学意义(P0.05)。联合Versalok锚钉组术后1个月、3个月及6个月的Lysholm评分分别为(69.973.84)分、(88.455.23)分和(94.341.46)分，均高于双ETHIBOND线组的(68.223.69)分、(82.244.12)分和(90.212.37)分，差异有统计学意义(P0.05)；联合Versalok锚钉组术后1个月、3个月及6个月的IKDC评分分别为(55.213.95)分、(86.623.12)分和(95.121.83)分，均高于双ETHIBOND线组的(53.264.12)分、(82.962.69)分和(90.112.64)分，差异有统计学意义(P0.05)。结论经关节镜下胫骨双隧道双ETHIBOND线联合Versalok锚钉内固定可有效缩短PCL胫骨止点撕脱骨折患者的骨折愈合速率，改善膝关节功能，提高临床疗效，且安全性较好。【关键词】后交叉韧带；胫骨止点撕脱骨折；关节镜；双隧道；ETHIBOND线；Versalok锚钉【中图分类号】R683.42【文献标识码】A【文章编号】10036350（2023）08110105Curative effect of knee arthroscopy with double ETHIBOND sutures combined with Versalok anchor internalfixation on tibial avulsion fractures of posterior cruciate ligament.YE Wu-zhi,ZHANG Shu-feng,GAO Chang-cheng.The Third Department of Orthopedics,Yulin Hospital of Traditional Chinese Medicine,Yulin 719000,Shaanxi,CHINA【Abstract】ObjectiveTo observe the curative effect of knee arthroscopy with double ETHIBOND suturescombined with Versalok anchor internal fixation on tibial avulsion fractures of posterior cruciate ligament(PCL).MethodsThe clinical data of 80 patients with tibial insertion avulsion fracture of PCL admitted to the Third Depart-ment of Orthopedics,Yulin Hospital of Traditional Chinese Medicine from August 2019 to August 2021 were retrospec-tively analyzed.According to different surgical methods,they were divided into double ETHIBOND suture group(41cases,knee arthroscopy with double ETHIBOND sutures)and combined Versalok anchor group(39 cases,Versalok an-chor internal fixation on basis of control group).The operation time,length of hospital stay,postoperative fracture reduc-tion,fracture healing time and changes in range of motion were compared between the two groups,and the occurrence ofpostoperative complications in both groups was recorded.ResultsThe fracture healing time in the combined Versalok an-chor group was(72.399.68)d,which was significnatly shorter than(84.1210.36)d in the double ETHIBOND suturegroup(P0.05).At 1,3,and6 months after surgery,Lysholm scores in the combined Versalok anchor group were(69.973.84)points,(88.455.23)points,and(94.341.46)points,which were significantly higher than(68.223.69)points,(82.244.12)points,and(90.212.37)points in the double ETHIBOND suture group(P0.05).At 1,3 and 6 months after surgery,IKDCscores in the combined Versalok anchor group were(55.213.95)points,(86.623.12)points,and(95.121.83)points,which were significnatly higher than(53.264.12)points,(82.962.69)points,(90.112.64)points in the double ET-HIBOND suture group(P0.05).ConclusionKnee arthroscopy with double ETHIBOND su-tures combined with Versalok anchor internal fixation can effectively shorten fracture healing time,improve knee func-tion and clinical curative effect in patients with tibial avulsion fractures of PCL,with good safety.【Key words】Posterior cruciate ligament;Tibial avulsion fracture;Arthroscope;Double tunnel;ETHIBOND su-ture;Versalok anchor 论著 doi:10.3969/j.issn.1003-6350.2023.08.007基金项目：陕西省社会发展科技攻关项目(编号：201701328)。第一作者：叶武智(1983)，男，研究方向：足踝部畸形、创伤的治疗、踝关节镜的应用以及足踝部各种创伤和常见畸形及运动损伤的治疗的临床研究工作。通讯作者：高长城(1979)，男，副主任医师，研究方向：四肢创伤和手足外科的治疗以及足踝部各种创伤和常见畸形及运动损伤的治疗的临床研究工作，E-mail：。1101海南医学2023年4月第34卷第8期Hainan Med J,Apr.2023,Vol.34,No.8后交叉韧带(posterior cruciate ligament，PCL)是维持膝关节稳定的主要结构之一，与前交叉韧带共同维持保护胫骨功能位的稳定，PCL损伤多因胫骨前侧遭受后应力所导致1-2。PCL胫骨止点撕脱骨折是PCL损伤中的一种较为特殊的类型，多见于运动与车祸损伤中，患者有较为明显的关节肿胀和功能受限的表现3。既往常以保守治疗或切开复位固定，均可有效缓解患者的关节症状，但前者因长期关节固定易导致患者关节僵硬，后续康复困难，而后者手术创伤较大，若护理不周切口感染的风险较大，不利于患者后续恢复。随着关节镜技术的不断发展，关节镜的应用在临床已广泛，具有创伤小，后续恢复好等优势，在关节损伤治疗中常用4-5。治疗PCL胫骨止点撕脱骨折关节镜内固定物多样，ETHIBOND线固定是临床常用的固定物，具有固定强度大且经济负担小等优点，可有效避免二次手术6，Versalok锚钉也是常用的固定物，具有较大的牵拉力，在韧带手术中也较为常用，但在PCL中应用少见。既往有研究显示，缝线联合锚钉可有效提高固定作用7。为此，本研究对经关节镜下胫骨双隧道双ETHIBOND线联合Versalok锚钉内固定治疗PCL胫骨止点撕脱骨折的疗效进行探讨，为临床提高数据支持。1资料与方法1.1一般资料回顾性分析2019年8月至2021年8月榆林市中医医院骨伤三科收治的80例后交叉韧带胫骨止点撕脱骨折患者和临床诊治资料。纳入标准：(1)均经影像学确诊为PCL胫骨止点撕脱性骨折8，且骨折块移位在5 mm以上，骨块横径在10 mm以上；(2)经查体均有膝关节活动受限表现，且后抽屉试验呈阳性；(3)术后随访时间6个月且临床资料完整。排除标准：(1)合并前交叉或副韧带损伤或存在韧带断裂者；(2)存在胫骨复合型骨折者；(3)存在严重膝关节炎性疾病者；(4)存在多种严重基础疾病者。根据不同的手术方案分为双ETHIBOND线组41例和联合Versa-lok锚钉组39例。本研究经院方医学伦理委员会审核通过。两组患者的基线资料比较差异均无统计学意义(P0.05)，具有可比性，见表1。表1两组患者的基线资料比较x-s，例(%)Table 1Comparison of baseline data between the two groups x-s，n(%)基线资料性别男女年龄(岁)受伤至手术时间(d)患侧左侧右侧平均骨块横径(mm)受伤原因运动车祸跌倒Meyers&Mc-Keever分型型型双ETHIBOND线组(n=41)28(68.91)13(31.71)32.452.049.124.2321(51.22)20(48.78)18.693.1220(48.78)14(34.15)7(17.07)28(68.29)13(31.71)联合Versalok锚钉组(n=39)27(69.23)12(30.77)31.962.299.234.1719(48.72)20(51.28)18.713.2319(48.72)10(25.64)10(25.64)27(69.23)12(30.77)2/t值0.0080.0501.1720.008P值0.9280.823