Guo Huihui, Zhao Yao, Gao Liang, Wang Chen, Shang Xianbo, Fan Haitao, Cheng Wendan, Liu Chang
Department of Orthopedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, China.
Fuyang People's Hospital, Fuyang, China.
Front Surg. 2023 Jan 6;9:885669. doi: 10.3389/fsurg.2022.885669. eCollection 2022.
The study aims to explore the feasibility and clinical effect of posterior minimally invasive treatment of cruciate ligament tibial avulsion fracture.
Posterior knee minimally invasive approach was used to treat avulsion fracture of posterior cruciate ligament (PCL) tibia in 15 males and 11 females. The length of the incision, intraoperative blood loss, operation time, postoperative hospital stay, residual relaxation, and fracture healing time were analyzed to evaluate the curative effect, learning curve, and advantages of the new technology. Neurovascular complications were recorded. During the postoperative follow-up, the International Knee Joint Documentation Committee (IKDC), Lysholm knee joint score, and knee joint range of motion were recorded to evaluate the function.
All 26 patients were followed up for 18-24 months, with an average of 24.42 ± 5.00 months. The incision length was 3-6 cm, with an average of 4.04 ± 0.82 cm. The intraoperative blood loss was about 45-60 ml, with an average of 48.85 ± 5.88 ml. The operation time was 39-64 min, with an average of 52.46 ± 7.64 min. The postoperative hospital stay was 2-5 days, with an average of 2.73 ± 0.87 days. All incisions healed grade I without neurovascular injury. All fractures healed well with an average healing time of 9.46 ± 1.33 weeks (range, 8-12 weeks). The Lysholm score of the affected knee was 89-98 (mean, 94.12 ± 2.49) at 12-month follow-up. The IKDC score was 87-95 with an average of 91.85 ± 2.19, and the knee range of motion was 129-148° with an average of 137.08 ± 5.59°. The residual relaxation was 1-3 mm, with an average of 1.46 ± 0.65 mm.
This minimally invasive method provides sufficient exposure for internal fixation of PCL tibial avulsion fractures without the surgical complications associated with traditional open surgical methods. The process is safe, less invasive, and does not require a long learning curve.
本研究旨在探讨后交叉韧带胫骨撕脱骨折后入路微创治疗的可行性及临床效果。
采用膝关节后入路微创方法治疗15例男性和11例女性的后交叉韧带（PCL）胫骨撕脱骨折。分析切口长度、术中出血量、手术时间、术后住院时间、残余松弛度及骨折愈合时间，以评估新技术的疗效、学习曲线及优势。记录神经血管并发症。术后随访期间，记录国际膝关节文献委员会（IKDC）评分、Lysholm膝关节评分及膝关节活动范围，以评估膝关节功能。
26例患者均获随访，随访时间18 - 24个月，平均24.42±5.00个月。切口长度3 - 6cm，平均4.04±0.82cm。术中出血量约45 - 60ml，平均48.85±5.88ml。手术时间39 - 64分钟，平均52.46±7.64分钟。术后住院时间2 - 5天，平均2.73±0.87天。所有切口均Ⅰ期愈合，无神经血管损伤。所有骨折均愈合良好，平均愈合时间9.46±1.33周（8 - 12周）。随访12个月时，患膝Lysholm评分为89 - 98分（平均94.12±2.49分）。IKDC评分为87 - 95分，平均91.85±2.19分，膝关节活动范围为129 - 148°，平均137.08±5.59°。残余松弛度为1 - 3mm，平均1.46±0.65mm。
这种微创方法为PCL胫骨撕脱骨折的内固定提供了充分的暴露，且无传统开放手术方法相关的手术并发症。该手术过程安全，创伤小，且无需较长的学习曲线。
