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自制导向器由后向前固定后交叉韧带撕脱骨折

Self-developed guide posterior-anterior to reduce and fix posterior cruciate ligament avulsion tibial fracture

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[目的]介绍自制导向器由后向前固定后交叉韧带(posterior cruciate ligament,PCL)撕脱骨折的手术技术和初步临床结果.[方法]2020年6月-2022年6月使用自制导向器由后向前固定治疗PCL撕脱骨折患者16例.镜下检查及清理,经PCL与股骨内髁间进入后内侧室,建立后内侧入口,置入导向器,尖端位于胫骨结节外侧缘,经内侧入口置入套筒,定位于PCL骨折块下方,由后向前建立胫骨隧道.用缝合钩经PCL实质部偏前缘引入高强度缝线,通过PDS线引出胫骨隧道,袢钢板悬吊固定.[结果]16例患者均顺利完成手术,未出现血管、神经损伤,患者均获(9.7±2.8)个月随访.与术前相比,末次随访时,IKDC 评分[(51.3±5.6)vs(91.4±3.1),P<0.001]、Lysholm 评分[(46.3±3.4)vs(89.7±3.3),P<0.001]均显著改善.骨折均愈合良好,膝关节稳定,屈伸活动良好.[结论]自制导向器由后向前固定后交叉韧带撕脱骨折,隧道建立精准,操作方便简单,可显著提高手术安全性.
[Objective]To introduce the surgical technique and preliminary clinical results of self-developed guide posterior-anterior to reduce and fix posterior cruciate ligament(PCL)avulsion tibial fracture.[Methods]From June 2020 to June 2022,16 patients received the self-developed guide posterior-anterior to reduce and fix PCL avulsion tibial fracture.After arthroscopic examination and debridement,the posterior medial compartment was entered anterior-posterior between the PCL and the medial femoral condyle to establish the postero-medial portals.Then the self-developed guide was placed,with the tip located at the lateral margin of the tibial tubercle,while a sleeve in-serted through the posteromedial portal aiming below the PCL fracture fragment to create tibial tunnel from the back to the front.The suture hook was used to introduce high-strength suture bundles through the PCL parenchyma,and the suture bundles were led out by PDS suture through the bone tunnel.Pulling out the suture bundles to reduce fracture,and fasten the sutures over button plate by tying to finish the sus-pension fixation.[Results]All the 16 patients were operated successfully without vascular or nerve damage,and were followed up for(9.7±2.8)months.Compared with those preoperatively,the IKDC score[(51.3±5.6)vs(91.4±3.1),P<0.001]and Lysholm score[(46.3±3.4)vs(89.7±3.3),P<0.001]significantly improved at the last follow-up.All the patients got fractures healed well,with stable knee and good flex-ion-extension range of motion.[Conclusion]This self-developed guide used for reduction and fixation of PCL tibial avulsion fracture from the back to the front has advantages of accurate tunnel establishment,convenient and simple operation manipulation,and high surgical safe-ty.

posterior cruciate ligamenttibial avulsion fracturetibial tunnelself-made guidearthroscopy

邓永、张季永、李小波、赵平

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芜湖市第一人民医院骨科,安徽芜湖 241000

后交叉韧带 撕脱骨折 胫骨隧道 自制导向器 关节镜

芜湖市科技计划芜湖市卫生健康委项目(2023)实用新型专利项目

2021cg23WHWJ2023y029ZL 2022 2 1041580.5

2024

中国矫形外科杂志
中国残疾人康复协会 中国人民解放军第八十八医院

中国矫形外科杂志

CSTPCD北大核心
影响因子:1.521
ISSN:1005-8478
年,卷(期):2024.32(16)
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