Department of Orthopedic Surgery, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India.
Knee Surg Sports Traumatol Arthrosc. 2012 Feb;20(2):315-21. doi: 10.1007/s00167-011-1618-6. Epub 2011 Jul 15.
The study was aimed to share the experience of managing posterior cruciate ligament (PCL) avulsion fractures of tibia with open reduction and internal fixation (ORIF). The study also evaluated the effect of delay in treatment and presence of occult PCL injury on the final outcome after surgery.
Forty-two patients (30 males and 12 females) with a median age of 26 years (range: 14-53 years) who underwent ORIF through a modified posterior approach for PCL fossa avulsion fractures were assessed after a median follow up of 18 months (range 10-42 months). In 30 patients surgery was performed within 3 weeks of injury. Fifteen patients had an occult intrasubstance PCL tear as seen on MRI. Assessment of results was made using Hughston criteria.
There was a statistically significant difference in the outcomes between acutely treated patients and patients with chronic injury. Although patients with acute fixation were found to fare better, the results were fair or good in majority of the patients (9 out of 12) with delayed presentation. Patients with occult injury to PCL had poorer outcomes and these results were found to be statistically significant.
ORIF for PCL avulsion fractures of tibia results in stable fixation, early mobilization and good functional outcomes. Although ORIF done acutely leads to best clinical outcomes, a delay in presentation (>3 weeks) does not necessarily contraindicate ORIF. An occult injury to PCL usually leads to inferior outcomes and primary PCL reconstruction should be considered as a viable option in these patients.
本研究旨在分享采用切开复位内固定（ORIF）治疗胫骨后交叉韧带（PCL）撕脱骨折的经验。本研究还评估了治疗延迟和隐匿性 PCL 损伤对术后最终结果的影响。
42 例患者（30 名男性和 12 名女性），平均年龄 26 岁（范围：14-53 岁），通过改良后入路行 ORIF 治疗 PCL 窝撕脱骨折，平均随访 18 个月（范围 10-42 个月）后进行评估。30 例患者在损伤后 3 周内进行手术。15 例患者 MRI 显示存在隐匿性 PCL 内撕裂。采用 Hughston 标准评估结果。
急性治疗患者与慢性损伤患者的结果存在统计学显著差异。虽然急性固定的患者预后较好，但大多数（12 例中有 9 例）延迟就诊的患者结果仍为良好或尚可。存在隐匿性 PCL 损伤的患者预后较差，结果具有统计学显著意义。
胫骨 PCL 撕脱骨折的 ORIF 可实现稳定固定、早期活动和良好的功能结果。虽然急性手术可获得最佳临床结果，但就诊延迟（>3 周）并不一定禁忌 ORIF。隐匿性 PCL 损伤通常导致预后较差，在这些患者中应考虑作为可行选择的原发性 PCL 重建。
