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Title: [Early effectiveness of minimally invasive open reduction and internal fixation versus arthroscopic double-tunnel suture fixation for tibial avulsion fracture of posterior cruciate ligament].
Author: Zhou P, Liu J, Xu Y, Wei D, Deng X, Li Z.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2020 Jun 15; 34(6):707-712. PubMed ID: 32538560.
Abstract:
OBJECTIVE: To compare the early effectiveness of minimally invasive open reduction and internal fixation via posterior median approach versus arthroscopic double-tunnel suture fixation in treatment of tibial avulsion fracture of the posterior cruciate ligament (PCL). METHODS: A clinical data of 31 patients with the tibial avulsion fracture of the PCL and met the criteria between January 2015 and January 2019 was retrospectively analyzed. Nineteen patients (group A) were treated with open reduction and internal fixation with cannulated screw via posterior median approach. The other 12 patients (group B) were treated with arthroscopic double-tunnel suture fixation technique. There was no significant difference between the two groups ( P>0.05) in the gender, age, side of effected limb, the injury cause, the time from injury to operation, the combined meniscus injury, Meyers & McKeever classification and preoperative Lysholm score, Tegner score, International Knee Documentation Committee (IKDC) score, and the difference of tibial posterior displacement between bilateral knees. The operation time, postoperative complications, fracture healing, and the difference of tibial posterior displacement between bilateral knees, Lysholm score, Tegner score, and IKDC score were recorded. RESULTS: Group B spent significantly longer operation time than group A ( t=7.347, P=0.000). No postoperative complication occurred in group B, and 1 patient in group A had a screw breakage. All patients were followed up 6-36 months (mean, 22 months). X-ray films showed that all fractures healed at 3 months after operation. At last follow-up, there was no significant difference in the patients with normal knee range of motion between the two groups ( P=0.510). At last follow-up, the difference of tibial posterior displacement between bilateral knees, Lysholm score, Tegner score, and IKDC score in the two groups were superior to those before operation ( P<0.05); while there was no significant difference between the two groups ( P>0.05). CONCLUSION: For the tibial avulsion fracture of PCL, the minimally invasive open reduction and internal fixation and arthroscopic double-tunnel suture fixation can obtain similar early effectiveness. However, arthroscopic surgery has the advantages of being able to simultaneously deal with intra-articular combined injuries, avoiding internal fixator complications, and eliminating the need for secondary operation. 目的: 比较后正中小切口切开复位内固定与关节镜下双隧道缝线固定治疗后交叉韧带（posterior cruciate ligament，PCL）胫骨止点撕脱骨折的早期疗效。. 方法: 回顾性分析 2015 年 1 月—2019 年 1 月，收治并符合选择标准的 31 例 PCL 胫骨止点撕脱骨折患者临床资料。19 例采用后正中小切口切开复位内固定（A 组），12 例采用关节镜下双隧道缝线固定（B 组）。两组患者性别、年龄、患肢侧别、致伤原因、受伤至手术时间、合并半月板损伤情况、Meyers & McKeever 分型以及术前 Lysholm 评分、Tegner 评分、国际膝关节文献委员会（IKDC）评分、双侧胫骨后移距离差值等一般资料比较，差异均无统计学意义（ P>0.05），具有可比性。记录两组手术时间、术后并发症及骨折愈合情况，采用双侧胫骨后移距离差值及 Lysholm 评分、Tegner 评分、IKDC 评分评价膝关节功能。. 结果: B 组手术时间明显长于 A 组（ t=7.347， P=0.000）。B 组未出现术后并发症，A 组术后发生螺钉断裂 1 例。31 例患者均获随访，随访时间 6～36 个月，平均 22 个月。术后 3 个月 X 线片复查示两组骨折均愈合。末次随访时，两组膝关节活动度达正常范围患者构成比较，差异无统计学意义（ P=0.510）。末次随访时，两组双侧胫骨后移距离差值、Lysholm 评分、Tegner 评分、IKDC 评分均较术前明显改善，差异有统计学意义（ P<0.05）；但组间比较差异均无统计学意义（ P>0.05）。. 结论: 关节镜下双隧道缝线固定与后正中小切口切开复位内固定治疗 PCL 胫骨止点撕脱骨折早期临床疗效相似，但前者具有能同时处理关节内合并损伤、避免内固定物相关并发症、无需二次手术等优势。.

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