【摘要】 目的 探讨关节镜辅助下经腘窝小切口应用锚钉固定治疗后交叉韧带胫骨止点粉碎骨折的临床效果。 方法 2007年2月-2008年12月对22例急性后交叉韧带胫骨止点骨折患者，采用关节镜辅助下经腘窝小切口切开复位，利用缝合锚钉重建止点，固定治疗后测试交叉韧带的张力和稳定，采用Lysholm膝关节功能评分评定膝关节功能。 结果 骨折平均愈合时间为6周，平均屈膝活动度（120±3）°。Lysholm膝关节功能评分为（92±2）分。 结论 关节镜辅助经腘窝小切口锚钉固定治疗后交叉韧带胫骨止点粉碎骨折，可协助诊断关节内韧带及骨折损伤情况，对韧带止点进行重建，操作简便，早期功能锻炼有助于关节功能恢复。【Abstract】 Objective To explore surgical technique and the results of arthroscopic reduction and fixation for the treatment of comminuted fracture of the posterior cruciate ligament (PCL) from the tibia using suture anchor through an posterolateral portal via popliteal fossa. Methods Twenty-two patients who were operated through an posterolateral portal via popliteal fossa, the fragment was fixed by using suture anchor to reestablish the insertion, test the tension and stabilization of PCL. Lysholm score was used to evaluate the knee function. Results The bone union was confirmed by X-ray films at the 6 weeks postoperatively. The ROM of knee joint relaxation was 120±3°. The Lysholm score was 92±2. Conclusion The displaced fragment of the comminuted fracture of the posterior cruciate ligament from the tibia can be reduced and fixed with the suture anchor arthroscopicly. Using suture anchors demonstrate a reliable and easy to use technique. Operation under arthroscopy helps diagnose and treat other complications inside knee joint. In addition, early functional exercise contributes torapid recovery of knee joint’s function.
ObjectiveTo compare the effectiveness of open reduction of posterior cruciate ligament (PCL) avulsion fracture at tibial insertion of knee joint with absorbable screws fixation and absorbable screw combined with suture anchor fixation. Methods The clinical data of 26 patients with PCL avulsion fracture at tibial insertion who met the selection criteria between March 2015 and October 2021 were retrospectively analyzed. Among them, 14 patients were fixed with simple absorbable screw (group A), and 12 patients were fixed with absorbable screw combined with suture anchors (group B). All patients were confirmed by X-ray film, CT, or MRI preoperatively, and got positive results in preoperative posterior drawer tests. There was no significant difference in gender, age, side of affected limb, time from injury to operation, comorbidities, and preoperative Meyers & McKeever classification, Lysholm score, and International Knee Documentation Committee (IKDC) score between the two groups (P>0.05). The operation time and postoperative complications were recorded and compared between the two groups. At last follow-up, Lysholm score and IKDC score were used to evaluate the improvement of knee function. ResultsThere was no significant difference in operation time between the two groups (P>0.05). All incisions healed by first intention, and no complication such as vascular and nerve injury or venous thrombosis occurred. All 26 patients were followed up 9-89 months, with an average of 55.3 months. The follow-up time of group A and group B was (55.7±23.2) and (56.8±29.3) months, respectively, with no significant difference (t=−0.106, P=0.916). Radiographs showed bone healing in both groups at 3 months after operation, and no complication such as infection and traumatic arthritis occurred. At last follow-up, the posterior drawer test was negative in both groups, and the Lysholm score and IKDC score significantly improved when compared with the pre-operative values (P<0.05). However, there was no significant difference in the improvement value between the two groups (P>0.05). ConclusionFor PCL avulsion fracture at tibial insertion of the knee joint, the open reduction and absorbable screw combined with suture anchor fixation can achieve reliable fracture reduction and fixation, which is conducive to the early rehabilitation and functional exercise, and the postoperative functional recovery of the knee joint is satisfactory.
Objective To investigate the surgical techniques and the cl inical outcomes of treating severe pronationexternal rotation ankle fractures combined with deltoid l igament injuries. Methods Between July 2005 and April 2007, 17 patients with grade-IV pronation-external rotation ankle fractures combined with deltoid l igament injuries were treated by open reduction and internal fixation with l igament repair by using suture anchors. There were 13 males and 4 femaleswith an average age of 36.5 years (21-56 years). All cases were closed injuries with l imitation of motion after initial physical examination. The X-ray and CT showed that all patients were characterized with lateral and posterior malleolus fractures and significant lateral shift of talus, but without medial malleous fracture before operation. All fractures were classified into grade-IV pronation- external rotation or type C according to Lauge-Hansen criterion and Danis-Weber standard respectively. The disease course was from 4 days to 7 days with an average of 5.6 days. Results All incisions healed by first intention Seventeen patients were followed up 11-24 months (mean 15.6 months). The X-ray films showed that all patients achieved bony heal ing. The heal ing time was 11-16 weeks (mean 14.8 weeks). According to the Baird-Jackson’s scoring system, the results were excellent in 5 cases, good in 9 cases, fair in 2 cases and poor in 1 case, the excellent and good rate was 82.4%. No operation compl ication occurred. Medial clear space was significantly decreased postoperatively compared with that before operation [(3.16 ± 0.37) mm vs. (4.87 ± 0.43) mm] (P lt; 0.01). In gravity stress radiographs, there was no significant difference in medial clear space between collateral ankle and injured ankle after operation [(3.47 ± 0.43) mm vs. (3.55 ± 0.44) mm] (P gt; 0.05). Conclusion It is emphasized that full attention should be given to reconstruction of medial l igament structures as well as open reduction and internal fixation in treating grade-IV pronation-external rotation ankle fractures combined with deltoid l igament injuries.
ObjectiveTo evaluate and compare the effectiveness of double Endobutton technique and suture anchor combined Endobutton plate in the treatment of Tossy type Ⅲ acromioclavicular joint dislocation. MethodsBetween May 2010 and March 2014, a retrospective study was preformed on 56 patients with Tossy type Ⅲ acromioclavicular joint dislocation. The coracoclavicular ligament was reconstructed with double Endobutton technique in 31 cases (Endobutton group), and with suture anchor combined Endobutton plate in 25 cases (Anchor group). There was no significant difference in age, gender, injury causes, injury side, associated injury, medical comorbidities, and disease duration between 2 groups (P>0.05). The operation time, medical device expenses, postoperative complications, preoperative and postoperative Constant-Murley scores, and postoperative Karlsson grading of the injured shoulder were compared between 2 groups. ResultsThe average operation time in Endobutton group was significantly greater than that in Anchor group (t=4.285, P=0.000); there was no significant difference in the medical device expenses between 2 groups (t=1.555, P=0.126). Primary healing of incision was obtained in all patients of 2 groups; no early complications of infection and skin necrosis occurred. All patients were followed up 15.6 months on average (range, 11-35 months). During follow-up, some loss of reduction and ectopic ossification in the coracoclavicular gap were observed in 1 case and 6 cases of Endobutton group, respectively. No recurrence of acromioclavicular joint dislocation, implant fixation loosening and broken, and secondary fractures occurred in the other patients. There was significant difference in the incidence of postoperative complications between 2 groups (P=0.013). Constant-Murley scores of the injured shoulder significantly increased at 9 months after operation when compared with preoperative values in 2 groups (P<0.05), but no significant difference was observed between 2 groups (P>0.05). At last follow-up, there was no significant difference in Karlsson grading between 2 groups (Z=-0.628, P=0.530). ConclusionBoth double Endobutton technique and suture anchor combined Endobutton plate have good effectiveness in the treatment of Tossy type Ⅲ acromioclavicular joint dislocation. But the latter is associated with easier operation, less operation time, and less complications.
Objective To investigate the methods and effectiveness of surgical treatment for posteromedial corner (PMC) injury combined with anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) ruptures. Methods Between February 2009 and February 2012, 15 patients (15 knees) with PMC injury combined with ACL and PCL ruptures underwent PMC repair with suture anchor and ACL and PCL reconstruction. There were 7 males and 8 females with an average age of 39 years (range, 15-59 years). The causes of injury were traffic accident injury in 6 cases, sport injury in 7 cases, and sprain injury in 2 cases. The disease duration was 3-15 days with an average of 7 days. All patients presented positive results of anterior drawer test, posterior drawer test and valgus stress test, and dysfunction of knee joint. Of 15 cases, 3 had ACL and PCL ruptures, 5 had ACL rupture, 3 had ACL injury at the attachment point of the condyles crest, and 4 had PCL rupture; 9 had PMC tear at the femur insertion, 5 had PMC tear at the tibia insertion, and 1 had PMC tear in the body area. Results All incisions healed by first intention with no complication of infection or stiffness of knee. All cases were followed up 18.4 months on average (range, 10-36 months). At last follow-up, 14 cases had normal knee flexion and extension ranges, but 1 case had 10° limitation of the knee extension. Except 1 case which had weakly positive valgus stress test, the other patients showed negative results of anterior drawer test, posterior drawer test, and valgus stress test. Based on the improved Lysholm classification standard, the results were excellent in 8 cases, good in 5 cases, and fair in 2 cases; the excellent and good rate was 86.7%. Conclusion Early repair of the PMC and reasonable reconstruction of cruciate ligament can effectively restore the knee stability for patients with PMC injury combined with ACL and PCL ruptures.
ObjectiveTo investigate the effectiveness of arthroscopic multi-point fixation with anchor and suture in the treatment of tibial insertion avulsion fracture of anterior cruciate ligament (ACL) involving the anterior root of lateral meniscus (LM). Methods A retrospective analysis was conducted on the clinical data of 28 patients with tibial insertion avulsion fracture of ACL involving the anterior root of LM who were treated with arthroscopic multi-point fixation with anchor and suture between October 2017 and January 2023. There were 12 males and 16 females with the mean age of 26 years (range, 13-57 years). There were 20 cases of sports injury and 8 cases of traffic accident injury. In 2 cases of old fracture, the time from injury to operation was 45 days and 90 days, respectively; in 26 cases of fresh fracture, the time from injury to operation was 3-20 days (mean, 6.7 days). According to the Meyers-McKeever classification, there were 4 cases of type Ⅱ, 11 cases of type Ⅲ, and 13 cases of type Ⅳ. The preoperative Lysholm knee function score was 42.1±9.0, the International Knee Documentation Committee (IKDC) score was 40.0±7.3, and the Tegner score was 0.7±0.7. ResultsAll operations were successfully completed, and the incisions healed by first intention. All the 28 patients were followed up 5-60 months (mean, 20.4 months). During the follow-up, there was nocomplication such as infection, vascular or nerve injury, loosening or breakage of internal fixator, or stiffness of knee joint. Postoperative X-ray films showed satisfactory fracture reduction and firm fixation. All fractures healed clinically, and the healing time was 8-16 weeks (mean, 10.3 weeks). At last follow-up, Lachman test and anterior drawer test were negative. At last follow-up, Lysholm knee function score was 92.4±5.5, IKDC score was 91.6±4.4, and Tegner score was 5.2±1.1, which significantly improved when compared with preoperative scores (t=−22.899, P<0.001; t=−29.870, P<0.001; t=−19.979, P<0.001). ConclusionMulti-point fixation with anchor and suture in the treatment of tibial insertion avulsion fracture of ACL involving the anterior root of LM can not only fix the LM, but also effectively reduce and fix the avulsion fracture, which can obtain good effectiveness.
ObjectiveTo explore the effectiveness of non-absorbable suture or suture anchor fixation by anterior approach in the treatment of anteromedial facet fractures of the ulnar coronoid process. MethodsBetween February 2007 and February 2012,16 cases of anteromedial facet fractures of the ulnar coronoid process were treated with operation.There were 9 males and 7 females,aged 20-80 years (mean,43.5 years).The causes of injury were traffic accident injury in 7 cases,tumble injury in 5 cases,and falling injury from height in 4 cases.The time from injury to operation was 6.8 days on average (range,2-8 days).All cases had closed fractures.According to O'Driscoll classification,there were 4 cases of type Ⅱ a,7 cases of type Ⅱ b,and 5 cases of type Ⅱ c.Among 16 patients,7 had simple anteromedial facet fractures of the ulnar coronoid process,and 9 had associated injury,including terrible triad in 3,Monteggia fractures in 4,and olecranon fractures in 2.All fractures were fixed with non-absorbable suture in 10 cases,and with suture anchor in 6 cases.The Mayo Elbow Performance Score (MEPS),range of motion (ROM),and complications were used to assess the elbow function. ResultsThe incisions all healed by first intension,without neurovascular injury.Fifteen patients were followed up 10-48 months (mean,25.3 months).The X-ray films showed that all fractures healed,with the mean healing time of 17.5 weeks (range,11-30 weeks).At last follow-up,the mean MEPS score was 88.5(range,55-100);the results were excellent in 10 cases,good in 3 cases,fair in 1 case,and poor in 1 case,with an excellent and good rate of 86.7%.The mean ROM of flexion and extension was 118°(range,35-145°),and the mean ROM of forearm rotation was 138°(range,85-165°).One case had elbow instability,and 3 had slight pain.No heterotopic ossification and traumatic arthritis occurred during the follow-up. ConclusionThe anteromedial facet fractures of the ulnar coronoid process can be clearly exposed through anterior approach,and the fracture fixation using non-absorbable suture and suture anchor fixation usually can restore the elbow function.