Abdallah Ahmed Abdelbadie, Arafa Mohammed S
Department of Orthopedic Surgery, Suez Canal University Hospital, Egypt.
Department of Orthopedic Surgery, Fayoum University, Egypt.
Injury. 2017 Jul;48(7):1644-1649. doi: 10.1016/j.injury.2017.05.032. Epub 2017 May 26.
To assess the surgical technique and report the outcomes following fixation of PCL bony avulsions through mini-invasive posterior knee approach as described by Burks and Schaffer.
From June 2012 to July 2015, 27 patients enrolled in the study (21 males and 6 females). Fixation of tibial PCL avulsion fractures was done with one or two cannulated screws, or sutures through Burks and Schaffer's approach. The mean interval before surgery was 16days (1-70) .Patients was followed up for an average of 51 weeks. The outcome measures evaluated at final follow-up were (1) clinical stability as assessed by posterior drawer test, (2) radiologic union, (3) functional assessment by Lysholm score, and (4) gastrocnemius muscle strength as a measure of morbidity.
Average operative time was 43min. Improvement of both subjective Lysholm score (mean 93) and objective stability testing by posterior drawer test (returns to normal in 81.1% of patients) at the final follow-up. Good radiographic union at average of 5.6 weeks. No morbidity of the gastrocnemius with few complications.
The approach was fast and safe with excellent visualization. It allows surgeons to address other injuries in the same setting. It can be considered as a minimally-invasive open surgery without surgery-related morbidity. It is a reproducible technique that can be done at any trauma centre by surgeons with average experience. The subjective and objective results of the technique are excellent and comparable to the arthroscopic procedures that needs more specific centres with well-trained surgeons.
按照Burks和Schaffer所描述的方法，评估通过微创后膝入路固定后交叉韧带（PCL）撕脱性骨折的手术技术并报告其结果。
2012年6月至2015年7月，27例患者纳入本研究（21例男性，6例女性）。采用一根或两根空心螺钉，或通过Burks和Schaffer入路进行缝线固定胫骨PCL撕脱骨折。术前平均间隔时间为16天（1 - 70天）。患者平均随访51周。末次随访时评估的结果指标包括：（1）通过后抽屉试验评估的临床稳定性；（2）影像学愈合情况；（3）采用Lysholm评分进行功能评估；（4）以腓肠肌力量作为并发症的衡量指标。
平均手术时间为43分钟。末次随访时，主观Lysholm评分（平均93分）及后抽屉试验客观稳定性测试均有改善（81.1%的患者恢复正常）。平均5.6周时影像学愈合良好。腓肠肌无并发症，仅有少量其他并发症。
该入路快速、安全，视野良好。它使外科医生能够在同一手术中处理其他损伤。可被视为一种微创开放手术，无手术相关并发症。这是一种可重复的技术，任何创伤中心具有一般经验的外科医生均可实施。该技术的主观和客观结果均非常好，与需要更专业中心及训练有素的外科医生的关节镜手术相当。
