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Title: [MINIMALLY INVASIVE TREATMENT OF POSTERIOR CRUCIATE LIGAMENT AVULSION FRACTURE IN A FLOPPY LATERAL POSITION].
Author: Zhao J, Wang H.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2016 Sep 08; 30(9):1072-1075. PubMed ID: 29786357.
Abstract:
OBJECTIVE: To conclude the effectiveness of arthroscopy combined with Burks and SchaVer's approach in the treatment of posterior cruciate ligament (PCL) avulsion fractures in a floppy lateral position. METHODS: Between May 2010 and March 2014, 21 patients with PCL avulsion fractures were treated. There were 13 males and 8 females, aged 21 to 62 years (mean, 39.1 years). The causes included traffic accident injury in 10 cases, sports injury in 5 cases, and falling injury from height in 6 cases. The time from injury to hospital was 1-6 days (mean, 2.5 days). The results of posterior drawer test were all positive, and the results of anterior drawer test and lateral stress test were all negative. The Lysholm score was 28.0±5.5 before operation. And the American Orthopaedic Foot and Ankle Society (IKDC) score was 46.2±7.6 before operation. According to Meyer standards for fractures classification, 11 cases were rated as type II and 10 cases as type III. Arthroscopy was used to inspect and treat the intra-articular lesions, then avulsion fracture was fixed by Burks and SchaVer's approach in lateral position. Postoperative functional exercises were performed. RESULTS: Primary healing of incision was obtained, without nerve and vascular injury or joint infection. All patients were followed up 18-36 months (mean, 27.2 months). The X-ray films of the knee joint showed good fractures reduction and healing at 3 months after operation. The results of posterior drawer test and reverse Lachman test were negative. The knee range of motion was recovered to normal level. At last follow-up, the Lysholm score of the knee joint was significantly improved to 90.9±1.4 from preoperative one (t=54.584, P=0.000), and the IKDC score was significantly increased to 90.5±5.3 from preoperative one (t=15.638, P=0.000), including 19 cases of grade A and 2 cases of grade B. CONCLUSIONS: A combination of arthroscopy and Burks and SchaVer's approach for the treatment of PCL avulsion fractures in a floppy lateral position has the advantages of minimal invasion and safe approach, short operative time, and early postoperative rehabilitation exercises, so it can provide satisfactory function recovery of the knee joint. 目的: 总结采用漂浮体位下关节镜联合Burks and SchaVer's入路带线锚钉内固定治疗后交叉韧带（posterior cruciate ligament,PCL）胫骨止点撕脱骨折的临床疗效。. 方法: 2010年5月－2014年3月，收治21例PCL胫骨止点撕脱骨折患者。男13例，女8例；年龄21~62岁，平均39.1岁。致伤原因：交通事故伤10例，运动损伤5例，高处坠落伤6例。受伤至入院时间为1~6 d，平均2.5 d。后抽屉试验均为阳性，前抽屉试验及内、外侧翻应力试验均为阴性。术前膝关节Lysholm评分为（28.0±5.5）分；国际膝关节文献委员会（IKDC）评分为（46.2±7.6）分。骨折按Meyer分型标准，Ⅱ型11例，Ⅲ型10例。术中患者取漂浮体位，常规关节镜入路并处理关节内病变；然后患者更换体位固定于侧卧位，采用Burks and SchaVer's 入路，显露并固定撕脱骨折块。术后指导患者功能锻炼。. 结果: 术后切口均Ⅰ期愈合，无神经、血管损伤及关节感染等并发症发生。患者均获随访，随访时间18~36个月，平均27.2个月。术后3个月，X线片复查示膝关节骨折复位良好，骨折均愈合；后抽屉试验及反Lachman试验均为阴性。患者关节活动度恢复至伤前水平。末次随访时，膝关节Lysholm评分为（90.9±1.4）分，与术前比较差异有统计学意义（t=54.584，P=0.000）。IKDC评分为（90.5±5.3）分，与术前比较差异有统计学意义（t=15.638，P=0.000）；其中A级19例，B级2例。. 结论: 采用漂浮体位关节镜联合Burks and SchaVer’s入路带线锚钉内固定治疗PCL胫骨止点撕脱骨折，手术创伤小，入路安全可靠，术后允许早期康复锻炼，膝关节功能恢复满意。.

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