Department of Orthopedics, Lu'an Hospital of Anhui Medical University, Lu'an, 237001, China.
Anhui Medical University, Hefei, 230022, China.
J Orthop Surg Res. 2024 Jun 18;19(1):362. doi: 10.1186/s13018-024-04851-4.
The purpose of this study was to analyse the difference between arthroscopic fixation and open reduction internal fixation (ORIF) of posterior cruciate ligament (PCL) tibial avulsion fractures.
This retrospective study analysed patients with an acute PCL tibial avulsion fracture who underwent surgical treatment at our hospital and follow-up for at least 24 months. Variables based on sex, age, Meyers-McKeever type, surgical method, meniscus tear, external fixation, labour or sports, Lysholm knee score, IKDC score, and KT-1000 value were also recorded. Multifactor unconditional logistic regression and Student's t test with 1:1 propensity score matching (PSM) to remove confounding factors were used for analysis.
Sixty-five cases achieved knee function graded as "good" or better, and 9 cases not. Single-factor analysis indicated that Meyers-McKeever type (χ = 4.669, P = 0.031) and surgical approach (χ = 9.428, P = 0.002) are related to functional outcomes. Multifactorial logistic regression analysis further confirmed that Meyers-McKeever typing (OR = 10.763, P = 0.036, [95% CI 1.174-98.693]) and surgical approach (OR = 9.274, P = 0.008, [95% CI 1.794-47.934]) are independent risk factors affecting prognosis. In addition, PSM verified significant differences in the Lysholm score (t = 3.195, P = 0.006), IKDC score (t = 4.703, P = 0.000) and A-KT/H-KT (t = 2.859, P = 0.012). However, the affected-side KT-1000 value (A-KT, mm, t = 1.225, P = 0.239) and healthy-side KT-1000 value (H-KT, mm, t = 1.436, P = 0.172) did not significantly differ between the two groups. The proportions of cases in which the Lysholm score, IKDC and A-KT/H-KT exceeded the minimal clinically important difference (MCID) were 62.5% (20/32), 62.5% (20/32) and 93.75% (30/32), respectively.
Compared with ORIF, an arthroscopic approach for PCL tibial avulsion fractures achieves better results.
Retrospective cohort study; Level II.
本研究旨在分析关节镜固定与切开复位内固定（ORIF）治疗后交叉韧带（PCL）胫骨撕脱骨折的疗效差异。
本回顾性研究分析了在我院接受手术治疗并随访至少 24 个月的急性 PCL 胫骨撕脱骨折患者。记录的变量包括性别、年龄、Meyers-McKeever 分型、手术方法、半月板撕裂、外固定、体力劳动或运动、Lysholm 膝关节评分、IKDC 评分和 KT-1000 值。采用多因素非条件逻辑回归和 1:1 倾向评分匹配（PSM）以消除混杂因素的 Student's t 检验进行分析。
65 例患者膝关节功能分级为“良好”或更优，9 例为“差”。单因素分析表明，Meyers-McKeever 分型（χ²=4.669，P=0.031）和手术方式（χ²=9.428，P=0.002）与功能结局有关。多因素逻辑回归分析进一步证实，Meyers-McKeever 分型（OR=10.763，P=0.036，[95%CI 1.174-98.693]）和手术方式（OR=9.274，P=0.008，[95%CI 1.794-47.934]）是影响预后的独立危险因素。此外，PSM 验证了 Lysholm 评分（t=3.195，P=0.006）、IKDC 评分（t=4.703，P=0.000）和 A-KT/H-KT（t=2.859，P=0.012）的显著差异。然而，两组患侧 KT-1000 值（A-KT，mm，t=1.225，P=0.239）和健侧 KT-1000 值（H-KT，mm，t=1.436，P=0.172）差异无统计学意义。Lysholm 评分、IKDC 和 A-KT/H-KT 超过最小临床重要差异（MCID）的病例比例分别为 62.5%（20/32）、62.5%（20/32）和 93.75%（30/32）。
与 ORIF 相比，关节镜治疗 PCL 胫骨撕脱骨折的效果更好。
回顾性队列研究；Ⅱ级。
