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关节镜下复位固定治疗胫骨后交叉韧带撕脱骨折的临床疗效与骨折复位程度无关:一项回顾性研究。

The degree of fracture reduction does not compromise the clinical efficacy of arthroscopic reduction and fixation of tibial posterior cruciate ligament avulsion fractures: A retrospective study.

机构信息

Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China.

出版信息

Medicine (Baltimore). 2023 Sep 29;102(39):e35356. doi: 10.1097/MD.0000000000035356.

Abstract

This study aimed to explore the postoperative outcomes of patients who underwent arthroscopic internal fixation with repositioning sutures for the treatment of posterior cruciate ligament (PCL) avulsion fractures with poorly reduced fracture fragments. It was hypothesized that improperly repositioned fracture fragments might not influence the postoperative clinical outcomes in patients with PCL avulsion fractures treated by arthroscopic sutures. From January 2020 to December 2021, patients admitted to our hospital with PCL avulsion fractures were evaluated. Our inclusion criteria were as follows: diagnosis of PCL avulsion fracture as Meyers & McKeever Type II or Type III; underwent arthroscopic double tunnel suture fixation; and age below 70. Of the patients meeting these criteria, data from 34 individuals were collected by a designated follow-up officer. Based on postoperative imaging, the patients were divided into 2 groups: well fracture reduction and poor fracture reduction groups. Prior to the surgery, the Lysholm score, knee mobility, and international knee documentation committee (IKDC score) were recorded for both groups. At the 3-month post-surgery mark, CT-3D reconstruction was performed. Statistical analysis was conducted on the collected data. For data that conformed to a normal distribution, the t test was applied. For data that didn't conform, we used a non-parametric test. Both groups achieved successful wound healing without encountering any adverse events, such as fracture nonunion infection. Fracture healing was observed in both groups at the 3-month postoperative mark. The average follow-up duration was 13.24 ± 6.18 months. There were no significant differences in Lysholm score, IKDC score, or knee mobility between the well- and poorly-reduced groups at the final follow-up (P > .05). Postoperatively, both groups demonstrated significant improvements in knee function compared to the preoperative scores, with statistically significant differences observed in Lysholm score, IKDC score, and knee mobility (P < .05). Arthroscopic fixation with double-tunnel sutures proved to be a highly effective treatment approach for PCL avulsion fractures, even in cases where the fractures were poorly reduced. Remarkably, there were no significant differences observed in postoperative knee function between the well- and poorly-reduced groups, indicating that both groups achieved favorable outcomes.

摘要

本研究旨在探讨关节镜下复位缝线内固定治疗后交叉韧带(PCL)撕脱骨折中骨折块复位不良的患者的术后结果。假设对于关节镜缝线治疗的 PCL 撕脱骨折患者,骨折块未正确复位不会影响术后临床结果。2020 年 1 月至 2021 年 12 月,对我院收治的 PCL 撕脱骨折患者进行评估。纳入标准如下:Meyers 和 McKeever Ⅱ型或Ⅲ型 PCL 撕脱骨折诊断;接受关节镜双隧道缝线固定;年龄<70 岁。符合这些标准的患者中,由指定的随访人员收集了 34 名患者的数据。根据术后影像学结果,将患者分为两组:骨折复位良好组和骨折复位不良组。术前记录两组的 Lysholm 评分、膝关节活动度和国际膝关节文献委员会(IKDC)评分。术后 3 个月行 CT-3D 重建。对收集的数据进行统计学分析。对于符合正态分布的数据,采用 t 检验。对于不符合正态分布的数据,采用非参数检验。两组均顺利愈合,无骨折不愈合、感染等不良事件发生。两组患者均在术后 3 个月观察到骨折愈合。平均随访时间为 13.24±6.18 个月。末次随访时,骨折复位良好组和骨折复位不良组的 Lysholm 评分、IKDC 评分和膝关节活动度差异均无统计学意义(P>.05)。术后两组膝关节功能均较术前改善,Lysholm 评分、IKDC 评分和膝关节活动度差异均有统计学意义(P<.05)。关节镜下双隧道缝线固定治疗 PCL 撕脱骨折疗效确切,即使骨折复位不良也能取得良好效果。两组术后膝关节功能差异无统计学意义,提示两组均取得了良好的效果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e90a/10545087/2f1c4f7764db/medi-102-e35356-g001.jpg

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