Abstract:

Objective　To investigate the effect of posterior cruciate ligament (PCL) tibial insertion avulsion fracture treated by hollow screw internal fixation (HSIF) via very high posterior approach under arthroscopy. Methods　A total of 40 patients with tibial insertion avulsion fracture of PCL in Yantai Mountain Hospital from February 2019 to September 2021 were collected and were divided into group A (20 cases) and group B (20 cases) according to different surgical schemes. Group A included 12 males and 8 females, aged (37.33±6.16) years. Group B included 13 males and 7 females, aged (38.14±6.09) years. Group B received open reduction HSIF via modified Burks-Schaffer approach, and group A received HSIF via very high posterior approach under arthroscopy. The operation time, knee joint ranges of motion, Lysholm scores, International Knee Documentation Committee (IKDC) scores, and levels of traumatic stress factors [tumor necrosis factor-α (TNF-α), interleukin-1 (IL-1), IL-10, and C-reactive protein (CRP)] before and after operation, and posterior drawer test (PDT) result were compared between the two groups. t test, χ² test, and rank sum test were used. Results　The operation time of group A was longer than that of group B [(65.72±5.83) min] vs. (51.38±4.67) min], with a statistically significant difference (t=8.585, P<0.001). There were no statistically significant differences in the Lysholm and IKDC scores between the two groups before operation and 3 months and 6 months after operation (all P>0.05). One and three days after operation, the levels of serum TNF-α [(49.57±8.19) ng/L and (36.44±5.99) ng/L], IL-1 [(1.52±0.20) mg/L and (1.37±0.16) mg/L], IL-10 [(35.72±6.60) ng/L and (27.57±5.29) ng/L], and CRP [(24.46±3.37) mg/L and (19.42±2.77) mg/L] in group A were lower than those in group B [(66.42±10.68) ng/L, (58.19±7.64) ng/L, (2.33±0.27) mg/L, (2.14±0.22) mg/L, (48.11±8.52) ng/L, (36.37±7.18) ng/L, (32.49±5.83) mg/L, and (23.48±4.10) mg/L] (t=5.566, 10.019, 10.781, 12.659, 5.141, 4.413, 5.333, and 3.670; all P<0.001). There was no statistically significant difference in the PDT result between the two groups (P>0.05). Conclusions　Open reduction HSIF via modified Burks-Schaffer approach is as effective as HSIF via very high posterior approach under arthroscopy in the treatment of PCL tibial insertion avulsion fracture, both of which can effectively improve the function and range of motion of knee joint, but both have their advantages and disadvantages. The former takes less time to operate, and the latter has less impact on the stress of body trauma.

Key words:

Avulsion fracture, Tibial insertion, Posterior cruciate ligament, Knee joint, Very high posterior approach

摘要：

目的　探究关节镜下极后高位入路空心螺钉内固定（hollow screw internal fixation，HSIF）治疗后交叉韧带（posterior cruciate ligament，PCL）胫骨止点撕脱骨折患者的效果。方法　回顾性收集烟台市烟台山医院2019年2月至2021年9月PCL胫骨止点撕脱骨折患者40例为研究对象，按手术方案不同分为A组和B组，各20例。A组男12例、女8例，年龄（37.33±6.16）岁，接受关节镜下极后高位入路HSIF治疗；B组男13例、女7例，年龄（38.14±6.09）岁，接受改良Burks-Schaffer入路切开复位HSIF治疗。对比两组手术耗时，手术前后膝关节活动度、Lysholm评分、国际膝关节评分委员会（IKDC）评分、创伤应激因子［肿瘤坏死因子-α（TNF-α）、白细胞介素-1（IL-1）、IL-10、C反应蛋白（CRP）］水平，后抽屉试验（PDT）检查结果。采用t检验、χ²检验、秩和检验。结果　A组手术耗时［（65.72±5.83）min］长于B组［（51.38±4.67）min］，差异有统计学意义（t=8.585，P<0.001）。两组患者术前、术后3个月、6个月Lysholm、IKDC评分比较，差异均无统计学意义（均P>0.05）。术后1 d、3 d，A组血清TNF-α［（49.57±8.19）］ng/L、（36.44±5.99）ng/L］、IL-1［（1.52±0.20）mg/L、（1.37±0.16）mg/L］、IL-10［（35.72±6.60）ng/L、（27.57±5.29）ng/L］、CRP水平［（24.46±3.37）mg/L、（19.42±2.77）mg/L］均低于B组［（66.42±10.68）ng/L、（58.19±7.64）ng/L、（2.33±0.27）mg/L、（2.14±0.22）mg/L、（48.11±8.52）ng/L、（36.37±7.18）ng/L、（32.49±5.83）mg/L、（23.48±4.10）mg/L］（t=5.566、10.019、10.781、12.659、5.141、4.413、5.333、3.670，均P<0.001）。两组PDT检查结果比较，差异无统计学意义（P>0.05）。结论　改良Burks-Schaffer入路切开复位HSIF与关节镜下极后高位入路HSIF治疗PCL胫骨止点撕脱骨折患者效果相当，均能有效改善膝关节功能、膝关节活动度，但两者各有优劣，其中前者手术耗时更短，后者对机体创伤应激影响更小。

关键词:

撕脱骨折, 胫骨止点, 后交叉韧带, 膝关节, 极后高位入路