Wu J, Luo W, Ren F, Zheng H, Huang J
Second Ward of Sports Injuries and Arthroscopy, Tianjin Hospital, Tianjin, China.
Acta Chir Orthop Traumatol Cech. 2022;89(1):53-59.
PURPOSE OF THE STUDY To evaluate the therapeutic effects of small incision open reduction and internal fixation and arthroscopic high strength non-absorbable suture on tibial insertion avulsion fracture of the anterior cruciate ligament (ACL). MATERIAL AND METHODS In this prospectively study, 72 patients with ACL tibial insertion avulsion fracture treated from December 2017 to June 2020 were enrolled and divided into group A (treated with small incision open reduction and cannulated screw internal fixation) and group B (treated with arthroscopic high strength non-absorbable suture) using a random number table (n=36). Their general data, surgical indices and incidence of postoperative adverse reactions were compared. Knee function indices were compared before and after treatment, and evaluated by random walk model. RESULTS No significant differences were found in the general data, intraoperative blood loss, preoperative Lysholm score, International Knee Documentation Committee (IKDC) score, Tegner score, knee range of motion and difference of bilateral tibial forward displacement distance, and total incidence rate of postoperative adverse reactions between the two groups (P>0.05). Group B had significantly longer operation time, and significantly shorter hospital stay, time of first ambulation after operation and bone healing time than group A (P<0.05). Both groups had improved Lysholm score, IKDC score, Tegner score and knee range of motion after treatment, especially in group B (P<0.05). The difference of bilateral tibial forward displacement distance significantly reduced in both groups after treatment, particularly in group B (P<0.05). The random walk model revealed that group B had better improvement of knee function than group A. CONCLUSIONS Arthroscopic high strength non-absorbable suture in the treatment of ACL tibial insertion avulsion fracture can dramatically improve the knee function indices of patients, with rapid recovery and high safety, so it has a broad prospect of clinical application. Key words: small incision open reduction and internal fixation, arthroscopic high strength non-absorbable suture, tibial insertion avulsion fracture, anterior cruciate ligament, random walk model.
研究目的 评估小切口切开复位内固定术与关节镜下高强度不可吸收缝线治疗前交叉韧带（ACL）胫骨止点撕脱骨折的疗效。材料与方法 本前瞻性研究纳入2017年12月至2020年6月治疗的72例ACL胫骨止点撕脱骨折患者，采用随机数字表法分为A组（小切口切开复位空心螺钉内固定治疗）和B组（关节镜下高强度不可吸收缝线治疗），每组36例。比较两组患者的一般资料、手术指标及术后不良反应发生率。比较两组患者治疗前后的膝关节功能指标，采用随机行走模型进行评估。结果 两组患者的一般资料、术中出血量、术前Lysholm评分、国际膝关节文献委员会（IKDC）评分、Tegner评分、膝关节活动度及双侧胫骨前移距离差值、术后不良反应总发生率比较，差异均无统计学意义（P>0.05）。B组手术时间明显长于A组，住院时间、术后首次下地行走时间及骨折愈合时间明显短于A组（P<0.05）。两组治疗后Lysholm评分、IKDC评分、Tegner评分及膝关节活动度均有改善，B组改善更明显（P<0.05）。两组治疗后双侧胫骨前移距离差值均明显减小，B组减小更明显（P<0.05）。随机行走模型显示，B组膝关节功能改善情况优于A组。结论 关节镜下高强度不可吸收缝线治疗ACL胫骨止点撕脱骨折可显著改善患者膝关节功能指标，恢复快，安全性高，具有广阔的临床应用前景。关键词：小切口切开复位内固定术；关节镜下高强度不可吸收缝线；胫骨止点撕脱骨折；前交叉韧带；随机行走模型
