目的 比较关节镜下使用2枚Endobutton钢板与切开复位使用空心螺钉固定后交叉韧带(posterior cruci-ate ligament,PCL)胫骨止点撕脱骨折的临床疗效.方法 2015年3月至2018年6月我科收治急性PCL胫骨止点撕脱性骨折患者56例,其中男35例,女21例;年龄18～55岁,平均(29.51±15.02)岁.56例患者随机分为两组,26例采用关节镜下使用2枚Endobutton钢板结合高强线固定(关节镜组),30例采用改良的膝关节后内侧切口使用2枚空心螺钉固定(切开复位组).比较两组患者的手术时间、住院费用,术前、术后3d、术后1个月、术后1年膝关节疼痛评分,末次随访膝关节活动度、Lysholm评分、后抽屉试验阳性率及术后并发症等情况.结果 两组患者均获随访,随访时间12～19个月,平均(14.55±2.63)个月.末次随访所有患者骨折均愈合,无内固定失败、再次骨折发生.关节镜组较切开复位组手术时间长、住院费用高,两组比较差异有统计学意义(P<0.05).关节镜组术后3 d膝关节疼痛评分小于切开复位组,两组比较差异有统计学意义(P<0.05);两组患者术前、术后1个月、术后1年膝关节疼痛评分比较差异无统计学意义(P>0.05).两组患者末次随访膝关节活动度、ysholm评分、后抽屉试验阳性率比较,差异无统计学意义(P>0.05).结论 关节镜下使用2枚Endobutton袢钢板与改良膝关节后内侧入路使用空心螺钉治疗PCL止点撕脱骨折,均可获得良好的手术效果.关节镜组有微创、早期疼痛程度轻的优点,但手术时间较长、费用稍高.
Objective To investigate the incidence of complications following minimal invasive subcutaneous internal fixator (INFIX) for the treatment of anterior pelvic ring instability, and to analyze control measures. Methods Data of 42 patients with anterior pelvic ring instability who were treated by anterior subcutaneous internal fixation in our hospital from January 2016 to December 2017 were retrospectively analyzed. There were 15 females and 27 males with an average age of 45.4 years (range, 18-67 years). There were 26 traffic injuries, 10 falling injuries, 3 crush injuries and 3 low energy injuries. According to Tile classi?fication, 24 cases of B2 type, 16 cases of B3 type, 1 case of C1 type and 1 case of C2 type. According to Young?Burgess classifica?tion, there were 20 cases of LCI, 18 cases of LCII, 1 case of LCIII, 1 case of APCI, 1 case of APCII, and 1 case of VS. Fourteen cas?es were combined with limb fractures, and 11 cases were combined with thoracic or abdominal injuries requiring surgical treat?ment, while 16 cases were with brain injuries. For type APC2, LC1, and some LC2 fractures, fixation for the anterior pelvic ring is enough with INFIX technique alone. For some LC2, LC3, or VS fractures, the anterior and posterior ring were both fixed. Postoper?ative reduction was evaluated by Matta radiological criteria. Lateral thigh numbness and pain, quadriceps muscle power were re? corded during follow?up, and clinical efficacy was evaluated by Majeed score at 6 months after operation. Results All the 42 pa?tients were followed up for 6 to 12 months, with an average of 9.3 months. Matta standard evaluation for fracture reduction showed that 28 cases were excellent, 14 cases good, and the excellent and good rate was 100% . The early complication rate (within 3 month after operation) was 23.8% (10/42) including 6 cases of lateral femoral cutaneous nerve injury and 2 cases of femoral nerve injury. The symptoms were obviously relieved after the treatment of nutrient nerve and hyperbaric oxygen; 1 case had incision in?fection which was healed after anti?infection therapy and internal plant removal; 1 case suffered from superior gluteal artery injury which was controlled by pressure hemostasis. Six months after surgery, no case had lost reduction. At 6 months follow?up, the Ma?jeed score was 72-96, with an average of 84.96, of which 32 were excellent and 10 were good, thus the excellent and good rate was 100% (42/42). Conclusion INFIX is an effective internal fixation method for the treatment of unstable anterior pelvic ring inju?ry. However, it has a high rate of early complications, among which nerve injury has the highest incidence.
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