Frosch K -H, Proksch N, Preiss A, Giannakos A
Chirurgisch-Traumatologisches Zentrum, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland.
Oper Orthop Traumatol. 2012 Sep;24(4-5):348-53. doi: 10.1007/s00064-012-0208-1.
Reduction and fixation of bony avulsions of the posterior cruciate ligament (PCL) through a minimally invasive dorsal approach to restore stability of the knee joint. Prevention of soft tissue damage through a minimally invasive procedure and achieving early functional rehabilitation by stable osteosynthesis.
Bony tibial avulsions of the PCL and simple posteromedial tibial fractures.
Infections in or around the knee, critical soft tissue conditions and lack of patient compliance. OPERATION TECHNIQUE: Supine position, skin incision mediodorsal over the head of the medial gastrocnemius muscle. After dissection of soft tissue and superficial fascia the medial gasteocnemius muscle is retracted to the lateral side, nerves and vessels of the popliteal fossa are thereby protected. Incision of the posterior capsule from the tibial attachment, exposure of the fracture and the PCL, reduction of the fracture, fixation with two drill wires and definitive fixation with two cannulated screws. In case of multifragment fracture a suture anchor is used for fixation.
Partial weight bearing of 10-20 kg for 4-6 weeks and limitation of knee flexion up to 90° for 4 weeks.
Between November 2010 and November 2011 three patients were treated with the new minimally invasive posteromedial approach to fix bony avulsions of the PCL. In two cases an osteosynthesis with two screws was performed and in the other patient a comminuted avulsion fracture was fixed with a suture anchor. In the latter patient the posterolateral corner was additionally augmented according to Larson with an autologous semitendinosus tendon. No intraoperative or postoperative complications could be observed. In all three patients an excellent fracture reduction without steps or gaps could be achieved. In two cases an early functional treatment protocol and in one case (suture anchor fixation plus augmentation of the posterolateral corner) a special postoperative PCL rehabilitation protocol was used. Good clinical results with stable knee joints could be achieved in all cases. The minimally invasive dorsal approach for the treatment of bony avulsions of the PCL was demonstrated to be safe and simple with a low complication rate.
通过微创背侧入路对后交叉韧带（PCL）骨撕脱伤进行复位和固定，以恢复膝关节稳定性。通过微创手术防止软组织损伤，并通过稳定的骨合成实现早期功能康复。
PCL胫骨骨撕脱伤和单纯胫骨后内侧骨折。
膝关节内或周围感染、严重软组织状况以及患者依从性差。
仰卧位，在内侧腓肠肌头部上方作中背部皮肤切口。在解剖软组织和浅筋膜后，将内侧腓肠肌牵向外侧，从而保护腘窝的神经和血管。从胫骨附着处切开后关节囊，暴露骨折和PCL，复位骨折，用两根导针固定，并用两根空心螺钉进行最终固定。对于多块骨折，使用缝合锚进行固定。
4至6周内部分负重10 - 20千克，4周内膝关节屈曲限制在90°以内。
2010年11月至2011年11月期间，3例患者采用新的微创后内侧入路治疗PCL骨撕脱伤。2例采用双螺钉骨合成，另1例粉碎性撕脱骨折用缝合锚固定。在后者患者中，根据拉森方法，用自体半腱肌腱额外加强了后外侧角。未观察到术中或术后并发症。所有3例患者均实现了骨折的良好复位，无台阶或间隙。2例采用早期功能治疗方案，1例（缝合锚固定加后外侧角加强）采用特殊的术后PCL康复方案。所有病例均取得了膝关节稳定的良好临床效果。治疗PCL骨撕脱伤的微创背侧入路被证明安全、简单，并发症发生率低。
