目的探讨关节镜下锁扣带袢双钛板固定术治疗急性后交叉韧带胫骨止点撕脱性骨折的适应症及效果。方法2014年12月至2015年1月,2例急性后交叉韧带胫骨止点撕脱骨折患者,术前完善影像学检查及评估,在关节镜下行复位及锁扣带袢双钛板固定,术后积极康复训练。结果成功1例,术后早期开始康复训练;术后3个月,患者膝关节功能恢复满意。失败1例,改用空心螺钉内固定,术后推迟2周开始康复训练,术后4个月基本恢复正常膝关节功能。结论对于后交叉韧带胫骨止点撕脱骨折块体积较大、较为完整的非骨质疏松患者,采取关节镜下锁扣带袢双钛板固定术可达到骨折的解剖复位和坚强固定,有利于早期进行康复训练。
ObjectiveTo explore the efficacy of arthroscopic treatment for acute avulsion fracture of posterior cruciate ligament (PCL) using double titanium plate TightRope. MethodsFrom December 2014 to January 2015, two cases with acute avulsion fracture of PCL were treated with double titanium plate TightRope under arthroscopy, after assessment of three dimensional reconstructive CT and MRI. Rehabilitation was carried out after operation. ResultsOne case succeeded with double titanium plate TightRope, and rehabilitation could be performed early postoperatively. Another case failed in TightRope fixation, and accepted two internal hollow screws fixation instead. Rehabilitation was delayed until two weeks postoperatively. The function of the knee was satisfactory in the former patient after three months, who could extend the knee in a normal range, without pain or locking. The same effect was gained in the latter patient after four months. ConclusionFor acute tibial avulsion fracture of PCL with larger and intact fragment without osteoporosis, arthroscopic restoration and fixation with double titanium plate TightRope offers the opportunity to achieve anatomic reconstruction and rigid fixation for early rehabilitation in adult patients.
[1] 陈东阳,蒋青,李文. 关节镜下复位丝线固定治疗前交叉韧带下止点撕脱骨折[J]. 中华外科杂志, 2006, 44(4): 254-257.
[2] 张青松,李涛,方禹舜,等. 关节镜下“人”字缝线固定治疗后交叉韧带胫骨止点撕脱骨折[J]. 中华创伤骨科杂志, 2016, 18(11): 998-1000.
[3] 冯万文,夏亚一,党跃修,等. 关节镜下固定移位的胫骨髁间嵴撕脱性骨折[J]. 中华关节外科杂志(电子版), 2012, 6(2): 40-43.
[4] 王世强,黄文良,柏帆,等. 关节镜下张力带钢丝固定治疗胫骨髁间棘骨折18例[J]. 中华创伤杂志, 2014, 30(9): 928-929.
[5] Chen W, Tang D, Kang L, et al. Effects of microendoscopy-assisted reduction and screw fixation through a single mini-incision on posterior cruciate ligament tibial avulsion fracture [J]. Arch Orthop Trauma Surg, 2012, 132(4): 429-435.
[6] 陈维东. 关节镜下空心螺钉与缝线内固定治疗胫骨髁间棘骨折[J]. 中国组织工程研究, 2013, 17(52): 9017-9022.
[7] 卢弘栩,皇甫小桥,张君,等. 关节镜下空心螺钉固定治疗后交叉韧带胫骨止点撕脱骨折[J]. 实用骨科杂志, 2012, 18(9): 797-799.
[8] 潘江,温亮,林源,等. 双排锚钉线桥技术固定后交叉韧带胫骨止点撕脱骨折的疗效分析[J]. 中国矫形外科杂志, 2014, 22(12): 1077-1080.
[9] 陈志永,刘春晖,何昌隆,等. 关节镜下RetroButton-EndoButton钢板内固定治疗前交叉韧带胫骨止点撕脱骨折[J]. 中国骨与关节损伤杂志, 2014, 29(4): 393-394.
[10] 卢启贵,黄东红,李政,等. 关节镜下Endobutton固定治疗急性后交叉韧带胫骨止点撕脱性骨折[J]. 实用骨科杂志, 2015, 21(7): 667-669.
[11] Gerhardt C, Kraus N, Pauly S, et al. [Arthroscopically assisted stabilization of acute injury to the acromioclavicular joint with the double TightRope technique: One-year Results] [J]. [in German]. Unfallchirurg, 2013, 116(2): 125-130.
[12] 张黎明,汪志芳,施海伟. 关节镜辅助锁扣带袢双钛板TightRope置入修复肩锁关节脱位：早期即可坚强固定[J]. 中国组织工程研究, 2015, 19(9): 1441-1446.
[13] Nag HL. Seating of TightRope RT button under direct arthroscopic visualization in anterior cruciate ligament reconstruction to prevent potential complications [J]. Arthrosc Tech, 2012, 1(1): e83-e85.
[14] Adler GG. All-inside posterior cruciate ligament reconstruction with a GraftLink [J]. Arthrosc Tech, 2013, 2(2): e111-e115.
[15] 袁伶俐,徐斌,姜少伟,等. TightRope与EndoButton应用在交叉韧带重建中的效果比较[J]. 中国组织工程研究, 2016, 20(11): 1616-1622.
[16] Cioppa-Mosca J, Cahill JB, Cavanaugh JT, et al. 骨科术后康复指南手册[M]. 周谋望,叶伟胜,董立平,等,译. 天津:天津科技翻译出版公司, 2011: 282-289.
[17] Horas U, Meissner SA, Heiss C, et al. Arthroscopic fixation of posterior cruciate ligament avulsion fractures: A new minimally invasive technique [J]. Knee Surg Sports Traumatol Arthrosc, 2010, 18(6): 781-783.
[18] Wajsfisz A, Makridis KG, Van Den Steene JY, et al. Fixation of posterior cruciate ligament avulsion fracture with the use of a suspensory fixation [J]. Knee Surg Sports Traumatol Arthrosc, 2012, 20(5): 996-999.
[19] Gwinner C, Kopf S, Hoburg A, et al. Arthroscopic treatment of acute tibial avulsion fracture of the posterior cruciate ligament using the TightRope fixation device [J]. Arthrosc Tech, 2014, 3(3): e377-e382.
[20] Zhang X, Cai G, Xu J, et al. A minimally invasive postero-medial approach with suture anchors for isolated tibial avulsion fracture of the posterior cruciate ligament [J]. Knee, 2013, 20(2): 96-99.
[21] Jazayeri SM, Esmaili Jah AA, Karami M. A safe postero-medial approach to posterior cruciate ligament avulsion fracture [J]. Knee Surg Sports Traumatol Arthrosc, 2009, 17(3): 244-247.
[22] Fay CM. Complications associated with use of anterior cruciate ligament fixation devices [J]. Am J Orthop, 2011, 40(6): 305-310.
[23] Karaoglu S, Halici M, Baktir A. An unidentified pitfall of Endobutton use: case report [J]. Knee Surg Sports Traumatol Arthrosc, 2002, 10(4): 247-249.
[24] Yanmis I, Tunay S, Oğuz E, et al. Dropping of an Endobutton into the knee joint 2 years after anterior cruciate ligament repair using proximal fixation Methods [J]. Arthroscopy, 2004, 20(6): 641-643.
[25] Sheps DM, Reed JG, Hildebrand KA, et al. Supracondylarfemur fracture after endoscopic anterior cruciate reconstruction using an Endobutton [J]. Clin J Sport Med, 2006, 16(5): 428-429.
[26] 郭韵,杜良杰,李建军,等. 前交叉韧带重建术后膝关节的神经肌肉功能重塑[J]. 中国康复理论与实践, 2016, 22(1): 65-68.
