Zhao Jinzhong, He Yaohua, Wang Jianhua
Department of Arthroscopic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiaotong University, China.
Arthroscopy. 2006 Feb;22(2):172-81. doi: 10.1016/j.arthro.2005.10.020.
The purpose of this study was to evaluate the clinical results of arthroscopic treatment of tibial avulsion fracture of the posterior cruciate ligament (PCL) with suture fixation technique through Y-shaped bone tunnels.
Retrospective case series.
We treated 29 cases of acute PCL tibial avulsion fracture arthroscopically through double posteromedial portals. The PCL and avulsion bony fragment was fixed with 2 No. 6 polyester sutures, which were pulled out through Y-shaped bone tunnels and fixed on a titanium button. The 2 branch openings of the Y-shaped bone tunnels were at the posterior edge of the tibial bed; the common outer opening was at medial side of the tibial tubercle. Through twisting of the button, the suture were tightened to ensure the fixation. The patients were followed-up for more than 2 years and were evaluated according to the International Knee Documentation Committee, Lysholm, and Tegner rating scales.
There was no extension limitation. Except for 2 patients who had 5 degrees flexion limitation, all the patients gained normal flexion. Before surgery, all patients had 1 degrees to 2 degrees positive posterior drawer test, and KT-1000 examination showed that the side-to-side difference of the posterior drawer test was 7 to 14 mm, with an average of 10.3 +/- 1.7 mm. At the last follow-up, 1 patient had 1 degrees positive posterior drawer test, the other patients had negative posterior drawer tests. The side-to-side difference of the posterior drawer test was 0 to 2 mm in 28 patients, and 4 mm in 1 patient, with an average of 0.6 +/- 0.4 mm. The Lysholm score was 93 to 100, with an average of 97.4 +/- 1.4. The Tegner scores were 6.8 +/- 0.8 before injury, and 6.6 +/- 0.7 at the last follow-up (P > .05).
Arthroscopic treatment of acute tibial avulsion fracture of the PCL with this fixation technique can restore the stability and function of the joint in most patients. Visualization and manipulation through double posteromedial portals are convenient. Y-shaped bone tunnels and the button-twisting technique are useful to ensure the results of reduction and fixation.
Level IV.
本研究旨在评估采用缝线固定技术经Y形骨隧道关节镜治疗后交叉韧带（PCL）胫骨撕脱骨折的临床效果。
回顾性病例系列研究。
我们通过双后内侧入路对29例急性PCL胫骨撕脱骨折患者进行关节镜治疗。用2根6号聚酯缝线固定PCL及其撕脱骨块，缝线经Y形骨隧道引出并固定于钛纽扣上。Y形骨隧道的2个分支开口位于胫骨骨床后缘；共同的外侧开口位于胫骨结节内侧。通过扭转纽扣收紧缝线以确保固定。对患者进行了2年以上的随访，并根据国际膝关节文献委员会、Lysholm和Tegner评分量表进行评估。
无伸直受限。除2例患者有5度屈曲受限外，所有患者均获得正常屈曲。术前，所有患者后抽屉试验均为1度至2度阳性，KT-1000检查显示后抽屉试验的两侧差异为7至14毫米，平均为10.3±1.7毫米。末次随访时，1例患者后抽屉试验为1度阳性，其他患者后抽屉试验为阴性。28例患者后抽屉试验的两侧差异为0至2毫米，1例患者为4毫米，平均为0.6±0.4毫米。Lysholm评分为93至100分，平均为97.4±1.4分。受伤前Tegner评分为6.8±0.8分，末次随访时为6.6±0.7分（P>.05）。
采用这种固定技术关节镜治疗急性PCL胫骨撕脱骨折可使大多数患者恢复关节的稳定性和功能。通过双后内侧入路进行可视化操作很方便。Y形骨隧道和纽扣扭转技术有助于确保复位和固定效果。
四级。
