急性移位性后交叉韧带胫骨止点撕脱骨折的临床疗效：关节镜下缝合与 EndoButton 固定技术的回顾性对比研究。
Clinical outcomes of acute displaced posterior cruciate ligament tibial avulsion fracture: A retrospective comparative study between the arthroscopic suture and EndoButton fixation techniques.
机构信息
Department of Orthopaedics, The Second Affiliated Hospital of Kunming Medical University, No374, dianmian road, Kunming, China.
Department of Orthopaedics, The People Hospital of XiShuangBanNa State, China.
出版信息
Orthop Traumatol Surg Res. 2021 Apr;107(2):102798. doi: 10.1016/j.otsr.2020.102798. Epub 2020 Dec 16.
BACKGROUND
Tibial avulsion fracture of the posterior cruciate ligament is not rare in the clinic. Arthroscopic treatment is increasingly accepted, but the choice of fixation has been debated. This study aims to compare the clinical outcomes of suture and EndoButton fixation under arthroscopy for acute displaced posterior cruciate ligament avulsion fractures.
METHODS
A total 68 of 83 PCL tibial avulsion fracture cases from 2009 to 2016 were retrospectively reviewed. Some patients received arthroscopic suture initially, and later the others received arthroscopic EndoButton fixation. Associated lesions were treated if present. The Lysholm and International Knee Documentation Committee (IKDC) scores, KT-1000 arthrometry and plain radiography were evaluated at follow-up. The assessment data at two years of follow-up were used for comparing the two different fixation groups.
RESULTS
The follow-up time of 63 patients was more than 2 years. In total, 32 of the 63 patients were in the suture group, and 31 were in the EndoButton group. At two years of follow-up, knee function according to the Lysholm score was a mean of 92.5 with a 95% confidence interval [CI] of 89.45 to 96.40 in the suture group and a mean of 93.5 with a 95% CI of 90.52 to 97.28 in the EndoButton group (P=.785). More than 90% of patients in both groups rated their knee function as normal or nearly normal on IKDC subjective evaluation. KT-1000 arthrometry showed that there was no difference between the two groups, with 0 to 3mm of laxity in 91% of the cases in the suture group versus 90% of cases in the EndoButton group. All patients achieved bony healing within 3 months. No significant complications were noted in the study.
CONCLUSIONS
Both the arthroscopic suture and EndoButton fixation methods for acute displaced posterior cruciate ligament avulsion fractures resulted in comparably good clinical outcomes, radiologic healing, and stable knees at mid-term follow-up.
LEVEL OF EVIDENCE
III; retrospective comparative study.
背景
临床上并不罕见后交叉韧带胫骨撕脱骨折。关节镜下治疗越来越被接受，但固定方式仍存在争议。本研究旨在比较关节镜下缝线和 EndoButton 固定治疗急性移位性后交叉韧带撕脱骨折的临床疗效。
方法
回顾性分析 2009 年至 2016 年收治的 83 例后交叉韧带胫骨撕脱骨折患者，其中部分患者最初接受关节镜下缝线固定，后改为关节镜下 EndoButton 固定。若存在其他合并损伤，则一并处理。随访时评估 Lysholm 评分和国际膝关节文献委员会（IKDC）评分、KT-1000 关节测量仪和 X 线平片。采用 2 年随访时的评估数据比较两种不同固定方式的疗效。
结果
63 例患者的随访时间超过 2 年。其中，缝线组 32 例，EndoButton 组 31 例。2 年随访时，缝线组 Lysholm 评分平均为 92.5（95%置信区间 89.45 至 96.40），EndoButton 组为 93.5（95%置信区间 90.52 至 97.28）（P=.785）。两组患者中均有超过 90%的患者在 IKDC 主观评估中报告膝关节功能正常或接近正常。KT-1000 关节测量仪显示两组间无差异，缝线组 91%的病例有 0 至 3mm 的松弛，EndoButton 组为 90%。所有患者均在 3 个月内实现骨性愈合。研究中未发现明显并发症。
结论
关节镜下缝线和 EndoButton 固定治疗急性移位性后交叉韧带撕脱骨折，中期随访时临床疗效、影像学愈合及膝关节稳定性相当。
证据水平
III；回顾性比较研究。
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