Khatri K, Sharma V, Lakhotia D, Bhalla R, Farooque K
Department of Orthopaedics, GGS Medical College, Faridkot, India.
Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India.
Malays Orthop J. 2015 Jul;9(2):2-8. doi: 10.5704/MOJ.1507.004.
To report functional outcome in Posterior Cruciate Ligament (PCL) tibial avulsion fractures treated with open reduction and internal fixation through Burks and Schaffer approach. The patient specific functional outcome measures like IKDC grading together with objective grading with stress radiographs have rarely been used -to assess PCL tibial avulsion fractures.
Twenty seven patients (21 males and 6 females) were included in the study. The mean follow up duration was 22.30±6.82 months. They were assessed using international knee documentation committee (IKDC) grades, Lysholm scoring and stress radiography. The injury severity scores (ISS) of the patients were also recorded.
The mean Lysholm scores at the time of last follow up was 90.85±5.58. The IKDC grades achieved were normal in 20 patients, near normal in five and abnormal in two. The PCL laxity determined on active hamstring contraction stress radiography was grade I in 20 cases and grade II in seven cases. All patients had achieved bony union of tibial avulsion fractures at the time of last follow up. Statistically significant association was found between higher ISS and lower Lysholm scores. (t=3.455, p=0.0019). Good IKDC grades were associated with higher Lysholm scores (analysis of variance, F=32.51, p<.0001). There was no correlation between PCL laxity and functional outcome (t=.857, p = 0.399).
PCL tibial avulsion fractures treated through Burk and Schaffer approach with open reduction and internal fixation produces good results. The early rehabilitation without cast immobilisation prevents arthrofibrosis.
报告采用Burks和Schaffer入路切开复位内固定治疗后交叉韧带（PCL）胫骨撕脱骨折的功能结果。患者特异性功能结局指标，如IKDC分级，以及应力X线片的客观分级，很少用于评估PCL胫骨撕脱骨折。
本研究纳入27例患者（21例男性和6例女性）。平均随访时间为22.30±6.82个月。采用国际膝关节文献委员会（IKDC）分级、Lysholm评分和应力X线片对患者进行评估。还记录了患者的损伤严重程度评分（ISS）。
末次随访时Lysholm评分的平均值为90.85±5.58。IKDC分级为正常的有20例，接近正常的有5例，异常的有2例。主动腘绳肌收缩应力X线片测定的PCL松弛度，I级有20例，II级有7例。所有患者在末次随访时胫骨撕脱骨折均已实现骨性愈合。发现较高的ISS与较低的Lysholm评分之间存在统计学显著关联（t=3.455，p=0.0019）。良好的IKDC分级与较高的Lysholm评分相关（方差分析，F=32.51，p<0.0001）。PCL松弛度与功能结果之间无相关性（t=0.857，p = 0.399）。
采用Burk和Schaffer入路切开复位内固定治疗PCL胫骨撕脱骨折效果良好。早期不进行石膏固定的康复可预防关节纤维性变。
