关节镜双Endobutton钢板与切开固定PCL止点骨折的比较

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摘要目的比较关节镜下使用2枚Endobutton钢板与切开复位使用空心螺钉固定后交叉韧带(posterior cruciate ligament，PCL)胫骨止点撕脱骨折的临床疗效。方法 2015年3月至2018年6月我科收治急性PCL胫骨止点撕脱性骨折患者56例，其中男35例，女21例；年龄18~55岁，平均(29.51±15.02)岁。56例患者随机分为两组，26例采用关节镜下使用2枚Endobutton钢板结合高强线固定(关节镜组)，30例采用改良的膝关节后内侧切口使用2枚空心螺钉固定(切开复位组)。比较两组患者的手术时间、住院费用，术前、术后3 d、术后1个月、术后1年膝关节疼痛评分，末次随访膝关节活动度、Lysholm评分、后抽屉试验阳性率及术后并发症等情况。结果两组患者均获随访，随访时间12~19个月，平均(14.55±2.63)个月。末次随访所有患者骨折均愈合，无内固定失败、再次骨折发生。关节镜组较切开复位组手术时间长、住院费用高，两组比较差异有统计学意义(P＜0.05)。关节镜组术后3 d膝关节疼痛评分小于切开复位组，两组比较差异有统计学意义(P＜0.05)；两组患者术前、术后1个月、术后1年膝关节疼痛评分比较差异无统计学意义(P＞0.05)。两组患者末次随访膝关节活动度、ysholm评分、后抽屉试验阳性率比较，差异无统计学意义(P＞0.05)。结论关节镜下使用2枚Endobutton袢钢板与改良膝关节后内侧入路使用空心螺钉治疗PCL止点撕脱骨折，均可获得良好的手术效果。关节镜组有微创、早期疼痛程度轻的优点，但手术时间较长、费用稍高。

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关键词 ：后交叉韧带, 撕脱骨折, 关节镜, 切开复位, 骨折内固定

Abstract：Objective To compare the clinical efficacy between two Endobutton plates fixation under arthroscope and open reduction and cannulated screw fixation in tibial avulsion fracture of posterior cruciate ligament.Methods From March 2015 to June 2018，56 patients with acute tibial avulsion fracture of posterior cruciate ligament underwent surgery in our hospital who were randomly divided into two groups.26 patients underwent surgery with two Endobutton plates combined with high-strength line fixation under arthroscope (the arthroscope group).30 patients underwent surgery with modified posteromedial incision of knee by using two cannulated screws ( the open reduction group).The indicators such as operation time，hospitalization expenses，knee pain score before surgery and 3 days，1 month and 1 year after surgery，last follow-up in knee range of motion，Lysholm score，positive rate of posterior stress radiography and postoperative complications were recorded and analyzed for the comparison of two groups.Results All patients in both groups underwent successful operation without any incision-related complications.The operation time of the arthroscope group was longer than that of the open reduction group(P＜0.05).By comparing the hospitalization expenses，the cost of the arthroscope group was higher than that of the open reduction group(P＜0.05).In terms of the pain score in three days after surgery，the pain score of the arthroscope group was lower than that of the open reduction group (P＜0.05).There was no significant difference in knee pain scores between two groups based on the period of before operation，1 month and 1 year after operation (P＞0.05).There was no significant difference in knee range of motion in the last follow-up evaluation，Lysholm score，and the positive rate of posterior stress radiography (P＞0.05).Conclusion The usage of two Endobutton plates under arthroscope，and the usage of the modified posterior medial approach to the knee joint for the treatment of PCL abutment avulsion fracture with cannulated screws can both achieve good surgical results.The advantages such as minimally invasive and mild early pain are obvious in the arthroscope group，however，the operation time is longer and the cost is slightly higher of this group than that of the open reduction group.

Key words： posterior cruciate ligament avulsion fracture arthroscope open reduction internal fixation

基金资助:广西壮族自治区卫生和计划生育委员会自筹经费科研课题(Z20180510)

通讯作者: 阎海威

作者简介: 冯延松(1989－ )，男，医师，柳州市工人医院，广西医科大学第四附属医院创伤骨科，545005。

引用本文:

冯延松，石展英，胡居正，吴昊，王仁崇，阎海威 *. 关节镜双Endobutton钢板与切开固定PCL止点骨折的比较[J]. 实用骨科杂志, 2020, 26(4): 309-312.
Feng Yansong，Shi Zhanying，Hu Juzheng，et al. Arthroscopic Double Endobutton Versus Open Reduction and Internal Fixation for Tibial Avulsion Fracture of Posterior Cruciate Ligament. sygkzz, 2020, 26(4): 309-312.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2020/V26/I4/309

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