丁科 罗群强 韦积华 陆定贵 唐乾利 唐毓金 袁健 葛清卿

【摘要】 目的 采用Inlay小切口入路切開复位双锚钉内固定治疗后交叉韧带（PCL）胫骨止点撕脱性骨折，探讨此技术的临床疗效。

方法 分析2017年3月～2019 年3月收治的25例 PCL止点撕脱性骨折患者，均采用Inlay小切口切开复位双锚钉内固定，其中，男19例，女6例，年龄19～67岁，平均（41.76±12.32）岁，较完整的骨折块面积大小1.68～2.60 cm2，平均（2.17±0.28）cm2，所有患者术前术后均采用Lysholm 及IKDC评分系统评价膝关节功能恢复情况和影像学评估骨折愈合情况。

结果 所有患者均获得6～24个月随访，平均（16.76±5.02）个月，所有骨折均愈合。无切口感染、关节感染、下肢深静脉血栓、锚钉拔出、关节粘连等并发症发生。末次随访时IKDC膝关节主观评分从（47.04±4.23）分增加到（96.80±1.76）分，Lysholm膝关节功能评分从（46.72±4.77）分增加到（97.48±1.45）分，术后IKDC、Lysholm评分高于术前，比较差异均有统计学意义（P<0.001）。

结论 采用Inlay小切口入路切开复位双锚钉内固定治疗PCL胫骨止点撕脱性骨折，疗效确切，该术式具有显露充分、操作简便、创伤小和安全可靠等优点，适合各种骨折类型的PCL胫骨止点撕脱性骨折的治疗。

【关键词】 撕脱性骨折;后交叉韧带;锚钉固定;Inlay切口

中图分类号：R683.42   文献标志码：A   DOI：10.3969/j.issn.1003-1383.2021.04.006

Observation of effectiveness of Inlay minimally invasive open reduction and internal fixation with double anchors in the treatment of tibial avulsion fracture of posterior cruciate ligament

DING Ke1， 2， LUO Qunqiang1， WEI Jihua1， LU Dinggui1， TANG Qianli1， TANG Yujin1， YUAN Jian2， GE Qingqing2

（1. Trauma Center of Affiliated Hospital， 2. Graduate School， Youjiang Medical University for Nationalities， Baise 533000， Guangxi， China）

【Abstract】 Objective To investigate the clinical efficacy of Inlay minimally invasive open reduction and internal fixation with double anchors in the treatment of tibial avulsion fracture of posterior cruciate ligament （PCL）.

Methods 25 patients with tibial avulsion fracture of PCL admitted to hospital from March 2017 to March  2019 were analyzed. All patients were given Inlay minimally invasive open reduction and internal fixation with double anchors， among them， there were 19 males and 6 females， aged from 19 to 67 years， with an average of （41.76 ± 12.32） years. The area of relatively complete fracture block was 1.68–2.60 cm2， with an average of （2.17 ± 0.28） cm2. Lysholm and IKDC scoring system were used to evaluate the functional recovery of knee joint before and after operation， and fracture healing was evaluated by imaging.

Results All patients were followed up for 6 to 24 months， with an average follow-up of （16.76 ± 5.02） months， and all the fractures have healed. There were no postoperative complications such as incision infection， deep vein thrombosis  of lower extremity， anchor prolapse and joint adhesion， etc. IKDC knee subjective score increased from （47.04 ± 4.23） points to （96.80 ± 1.76） points at the last follow-up， and Lysholm knee function score increased from （46.72 ± 4.77） points to （97.48 ± 1.45） points. After operation， the IKDC and Lysholm scores were higher than those before operation， and the difference was statistically significant （P < 0.001）.

Conclusion Inlay minimally invasive open reduction and internal fixation with double anchors has definite effect in the treatment of tibial avulsion fracture of PCL. The operation has the advantages of full exposure， simple operation， small trauma， high safety and reliability， which is suitable for the treatment of tibial avulsion fracture of PCL in various fracture types.

【Key words】 avulsion fracture; PCL; anchor fixation; Inlay incision

后交叉韧带（posterior cruciate ligament， PCL）胫骨止点撕脱性骨折是PCL损伤的一种常见类型。其发生损伤会导致膝关节不稳，不能有效限制胫骨后移，使膝关节后向不稳[1]。如不进行修复可导致膝关节早期退行性改变[2]。对骨折进行早期复位内固定是许多学者的共识[3～7]。然而，对于PCL胫骨止点撕脱骨折的手术方式尚无统一的术式选择标准，主要的手术方式有关节镜和开放性手术。……