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Title: [Effectiveness analysis of minimally invasive safe approach to knee joint for treatment of avulsion fractures of tibial insertion of posterior cruciate ligament].
Author: Huang C, Chen B, Cao N, Tian Y.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2023 Jan 15; 37(1):1-5. PubMed ID: 36708107.
Abstract:
OBJECTIVE: To analyze the effectiveness of minimally invasive safe approach of the knee joint in the treatment of avulsion fractures of the tibial insertion of the posterior cruciate ligament (PCL). METHODS: The clinical data of 26 patients with avulsion fractures of tibial insertion of PCL treated with open reduction and internal fixation via minimally invasive safe approach of the knee joint between February 2019 and March 2022 were analyzed retrospectively. There were 18 males and 8 females with an average age of 45.5 years (range, 33-58 years). The causes of injury were traffic accident in 14 cases, falling from height in 7 cases, and sports injury in 5 cases. There were 15 cases of left knee and 11 cases of right knee. The preoperative Lysholm score of knee joint was 34.4±7.3 and the flexion range of motion of knee joint was (69±12)°. According to Meyers classification, there were 8 cases of type Ⅱ and 18 cases of type Ⅲ. The time from injury to operation ranged from 1 to 5 days, with an average of 2 days. RESULTS: The operation time was 40-70 minutes, with an average of 55 minutes; the intraoperative blood loss was 10-30 mL, with an average of 15 mL. Delayed incision healing occurred in 1 case after operation, and the incision healed after conservative treatment, and the incisions of the other patients all healed by first intention. Postoperative X-ray films showed satisfactory fracture reduction. All 26 patients were followed up 3-30 months, with an average of 22 months. No complication such as neurovascular injury, infection, and knee extension disorder occurred after operation. X-ray films at 3 months after operation showed that all fractures healed without displacement of the fracture ends; the posterior drawer test was negative. At last follow-up, the flexion range of motion of knee joint was (120±9)°, the Lysholm score was 90.7±3.8, which were significantly improved when compared with those before operation (t=16.376, P<0.001; t=47.665, P<0.001). CONCLUSION: The minimally invasive safe approach of the knee joint for the treatment of PCL tibial insertion avulsion fractures is easy to operate, with minimal surgical trauma, safe and reliable approach, and satisfactory recovery of knee joint function after operation. 目的: 探讨采用膝关节微创安全入路治疗后交叉韧带（posterior cruciate ligament，PCL）胫骨止点撕脱骨折的疗效。. 方法: 回顾分析2019年2月—2022年3月采用膝关节微创安全入路治疗的26例PCL胫骨止点撕脱骨折患者临床资料。男18例，女8例；年龄33～58岁，平均45.5岁。致伤原因：交通事故伤14例，高处坠落伤7例，运动伤5例。左膝15例，右膝11例。术前膝关节Lysholm评分为（34.4±7.3）分，膝关节屈曲活动度为（69±12）°。骨折按Meyers分型：Ⅱ型8例，Ⅲ型18例。受伤至手术时间1～5 d，平均2 d。. 结果: 手术时间40～70 min，平均55 min；术中出血量10～30 mL，平均15 mL。1例术后出现切口延迟愈合，经保守治疗后切口愈合，其余患者切口均Ⅰ期愈合。术后X线片示骨折复位满意。26例患者均获随访，随访时间3～30个月，平均22个月。术后均未发生神经血管损伤、感染及膝关节伸直障碍等并发症。术后3个月X线片示所有患者骨折均愈合，骨折端无移位；后抽屉试验均为阴性。末次随访时膝关节屈曲活动度为（120±9）°，膝关节Lysholm评分为（90.7±3.8）分，与术前比较差异均有统计学意义（t=16.376，P<0.001；t=47.665，P<0.001）。. 结论: 膝关节微创安全入路治疗PCL胫骨止点撕脱骨折操作简便，手术创伤小，手术入路安全可靠，术后膝关节功能恢复满意。.

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