Fractures, Avulsion

骨折,撕脱
  • 文章类型: Journal Article
    胫骨结节骨折是一种罕见的损伤,占所有骨phy损伤的0.4-2.7%。它们发生在青少年年龄组,经常在运动期间,如篮球和足球。通常使用修改的Ogden分类法对它们进行分类。了解解剖学和病理生理学对于这些骨折的治疗至关重要,预测并发症,并为患者和家属提供护理建议。当选择正确的治疗方式时,胫骨结节骨折通常具有良好的总体疗效。结合率很高,受伤前活动恢复率达到98%。本文为医生提供了有关这些伤害的分类和管理的指南,以确保根据当前文献和最佳实践给予适当的治疗。
    Fractures of the tibial tubercle are an uncommon injury, constituting 0.4-2.7% of all epiphyseal injuries. They occur in the adolescent age group, often during sports such as basketball and football. They are often classified using the modified Ogden classification. Understanding the anatomy and pathophysiology is essential in the management of these fractures, to predict complications and counsel patients and families on care. Tibial tubercle fractures generally have favourable overall outcomes when the correct treatment modality is chosen, with a high rate of union and a 98% return to preinjury activities. This article provides a guide for doctors on the classification and management of these injuries, to ensure that appropriate treatment is given according to current literature and best practice.
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  • 文章类型: Journal Article
    目的:评价关节镜下高强度缝线结合纽扣钢板悬吊固定治疗后交叉韧带(PCL)胫骨止点撕脱骨折的临床疗效。
    方法:我们回顾性分析了2020年7月至2023年8月在我院接受治疗的32例PCL胫骨撕脱骨折患者的临床资料。我们记录了手术时间,术中和术后并发症,并使用影像学评估骨折复位和愈合。使用视觉模拟评分法(VAS)评估疼痛和膝关节功能,膝盖运动范围,Lysholm得分,国际膝关节文献委员会(IKDC)评分。
    方法:案例系列;证据水平,4.
    结果:所有患者随访6~18个月,平均13.6个月。所有切口均成功愈合,无术后并发症。术后第一天的X线片显示骨折复位满意。术后3个月影像学证实骨折愈合,没有内固定失败。在最后的后续行动中,膝关节功能恢复良好,只有一名患者表现出I度后部抽屉试验阳性。此外,平均VAS评分为0。5(范围为0.0到1.0),积极的膝盖伸展是2。2°(范围0.0到5.0),膝关节活动度为137.7°(范围130.0至145.0)。Lysholm平均得分为91.5(范围为89.3至94.0),IKDC评分平均为83.8±3.7,这些结果与术前水平相比有统计学意义的改善(P<0.001)。
    结论:关节镜下高强度缝合结合纽扣钢板悬吊固定治疗PCL胫骨止点撕脱骨折有几个好处:微创,减少术后疼痛,启用早期功能锻炼,并提供令人满意的临床结果,并发症较少。
    OBJECTIVE: To assess the clinical efficacy of arthroscopic treatment for posterior cruciate ligament (PCL) tibial avulsion fractures using high-intensity suture binding combined with button plate suspension fixation.
    METHODS: We retrospectively analyzed clinical data from 32 patients with PCL tibial avulsion fractures treated at our hospital from July 2020 to August 2023. We recorded operation time, intraoperative and postoperative complications, and used imaging to assess fracture reduction and healing. Pain and knee function were evaluated using the Visual Analogue Scale (VAS), range of knee motion, Lysholm score, and International Knee Documentation Committee (IKDC) score.
    METHODS: Case series; Level of evidence, 4.
    RESULTS: All patients were followed for 6 to 18 months, averaging 13.6 months. All incisions healed successfully without postoperative complications. X-rays taken on the first postoperative day showed satisfactory fracture reduction. Three-month post-surgery imaging confirmed healed fractures and no internal fixation failures. At the final follow-up, knee function was well recovered, with only one patient exhibiting a positive posterior drawer test of degree I. Furthermore, the mean VAS score was 0. 5 (range 0.0 to 1.0), active knee extension was 2. 2° (range 0.0 to 5.0), and active knee flexion was 137.7° (range 130.0 to 145.0). The mean Lysholm score was 91.5(range 89.3 to 94.0), and the IKDC score averaged 83.8 ± 3.7, and these outcomes showed statistically significant improvement from preoperative levels (P < 0.001).
    CONCLUSIONS: Arthroscopic high-intensity suture binding combined with button plate suspension fixation for PCL tibial avulsion fractures offers several benefits: it is minimally invasive, results in less postoperative pain, enables earlier functional exercise, and provides satisfactory clinical outcomes with fewer complications.
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  • 文章类型: Journal Article
    BACKGROUND: Fractures of the knee extensor complex are relatively rare injuries in children. We distinguish between a pure tendon rupture and ruptures with bony avulsions. A mid-substance tear in children is a relatively rare injury, whereas bony avulsions due to skeletal immaturity are seen more often. Sole bony fractures of the patella also only account for a low number of paediatric related fractures. Sleeve fractures are characterized by an avulsion of cartilage and, usually, bone pulled off from the distal patella pole. Avulsion fractures of the tibia tubercle are found in the group of sportive adolescents.
    METHODS: Especially dislocated fractures should be conveyed to surgical therapy to avoid excessive bone callus. Timely diagnostics and an efficient and consistent treatment are recommended. Deformities and dislocated avulsions will regularly not remodel spontaneously during further growth. Therefore, it is mandatory to reconstruct the articular surface and the knee extensor complex to avoid future complications such as osteoarthritis or elongation of the knee extensors.
    UNASSIGNED: HINTERGRUND: Verletzungen des Kniestreckapparates sind selten bei Kindern und Jugendlichen. Differenzieren muss man zwischen den rein intraligamentären und den ansatznahen Verletzungen. Erstere sind eine absolute Rarität, wohingegen die Avulsionsverletzungen aufgrund der Immaturität des kindlichen Skelettes die Mehrheit bilden. Als rein ossäre Verletzung des kindlichen Kniestreckapparates ist die Patellafraktur im Kindesalter eher selten. Bei Avulsionsverletzungen im Bereich der Patella wird regelhaft am unteren Patellapol eine osteochondrale Schuppe aus dem Verbund gerissen. Daneben gibt es den Apophysenausriss der Tuberositas tibiae, der klassischerweise beim sportlich aktiven Adoleszenten auftritt.
    UNASSIGNED: Gerade die dislozierte Form sollte operativ versorgt werden, um lokale Irritationen durch überschießende Kallusreaktion vorzubeugen. Entscheidend bei allen Verletzungen des kindlichen Kniestreckapparates im Wachstumsalter sind eine frühe Diagnosestellung und die rasche, adäquate Therapie. Spontane Korrekturen von dislozierten Avulsionsverletzungen sind bei verbliebenem Restwachstum nicht zu erwarten. Es gilt daher eine stufenfreie Wiederherstellung der Gelenkflächen sowie eine stabile Rekonstruktion des Streckapparates zu erreichen, um einer späteren Arthrose oder einer Elongation des Kniestreckapparates vorzubeugen.
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  • 文章类型: Journal Article
    目的:本研究的目的是探讨关节镜下前交叉韧带(ACL)胫骨止点撕脱骨折固定中不同螺钉位置的初始稳定性。
    方法:采用90°屈曲的三维膝关节模型,通过不同的门路模拟III型ACL胫骨撕脱骨折和关节镜螺钉固定,即中央跨髌腱门(CTP),前外侧门静脉(ALP),前内侧入口(AMP),外侧髌旁门静脉(LPP),髌旁内侧门静脉(MPP),髌上外侧门静脉(LSP),内侧髌上门静脉(MSP)。在30°弯曲时对有限元模型施加450N的剪切力以模拟破坏条件。在螺钉路径周围计算骨碎片的位移和超过25,000µ应变的骨体积(受损的骨体积)。
    结果:当通过CTP植入螺钉时,骨块的位移达到最大位移1.10mm,螺钉路径周围的最大受损骨量为148.70mm3。另一方面,通过LSP和MSP植入螺钉时,骨块的最小位移为0.45mm。当通过MSP植入螺钉时,螺钉路径周围的最小受损骨体积为14.54mm3。
    结论:通过较高的内侧入口植入的螺钉产生了较小的骨块位移,并在螺钉路径周围产生了最小的有害应变。这些发现与临床相关,因为它们为优化关节镜ACL胫骨撕脱骨折固定中的螺钉放置提供了生物力学证据。
    OBJECTIVE: The objective of this study was to investigate the initial stability of different screw placements in arthroscopic anterior cruciate ligament (ACL) tibial avulsion fracture fixation.
    METHODS: A three-dimensional knee model at 90° flexion was utilized to simulate type III ACL tibial avulsion fracture and arthroscopic screw fixation through different portals, namely the central transpatellar tendon portal (CTP), anterolateral portal (ALP), anteromedial portal (AMP), lateral parapatellar portal (LPP), medial parapatellar portal (MPP), lateral suprapatellar portal (LSP), medial suprapatellar portal (MSP). A shear force of 450 N was applied to the finite element models at 30° flexion to simulate the failure condition. The displacement of the bony fragment and the volume of the bone above 25,000 µ-strain (damaged bone volume) were calculated around the screw path.
    RESULTS: When the screw was implanted through CTP, the displacement of the bony fragment reached the maximum displacement which was 1.10 mm and the maximum damaged bone volume around the screw path was 148.70 mm3. On the other hand, the minimum displacement of the bony fragment was 0.45 mm when the screw was implanted through LSP and MSP. The minimum damaged bone volume was 14.54 mm3 around the screw path when the screw was implanted through MSP.
    CONCLUSIONS: Screws implanted through a higher medial portal generated less displacement of the bony fragment and a minimum detrimental strain around the screw path. The findings are clinically relevant as they provide biomechanical evidence on optimizing screw placement in arthroscopic ACL tibial avulsion fracture fixation.
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  • 文章类型: Journal Article
    目的:本研究旨在评估前交叉韧带(ACL)胫骨止点撕脱骨折改良缝合桥技术固定的临床和放射学结果。
    方法:对2018年1月至2022年1月行关节镜下复位改良缝合桥固定治疗ACL胫骨止点撕脱性骨折的未成年人进行回顾性分析。术后进行MRI和X线检查以评估骨phy板损伤和骨折愈合的存在。此外,KT-1000侧面差异,拉赫曼测试,运动范围(ROM),国际膝关节文献委员会(IKDC)的主观膝关节评分,Lysholm膝盖得分,术前和至少1年随访时评估Tegner活动等级评分。
    结果:共有16名参与者符合纳入标准。他们的平均年龄为12.6岁(范围,9-16岁);平均手术时间,6.9天(范围,2-13天),并进行了至少12个月的临床随访(平均,25.4个月;范围,12-36个月)手术后。术后X线片和MRI显示骨phy板无损伤,手术后立即进行最佳还原,和骨愈合在三个月内所有患者。以下各项均显示出显着的改善(前与术后):平均KT-1000左右差异(8.6vs.1.5;p<0.05),拉赫曼测试(2年级9和3年级7vs.0级12级和1级4级;p<0.05),IKDC主观评分(48.3vs.95.0;p<0.05),平均Lysholm得分(53.9vs.92.2;p<0.05),平均Tegner活动得分(3.2与8.3;p<0.05)和平均ROM(42.9°vs133.1°;p<0.05)。
    结论:关节镜下复位改良缝合桥固定治疗ACL胫骨止点撕脱骨折是一种可靠的、值得推荐的治疗方法,能有效恢复膝关节的稳定性和功能,值得临床推广。
    OBJECTIVE: This study aimed to evaluate the clinical and radiological outcomes of modified suture-bridge technique fixation for anterior cruciate ligament (ACL) tibial avulsion fracture.
    METHODS: Minors who underwent arthroscopic reduction and modified suture bridge fixation of ACL tibial avulsion fracture between January 2018 and January 2022 were retrospectively analyzed. Postoperative MRI and X-ray examinations were performed to evaluate the presence of epiphyseal plate injury and fracture healing. Moreover, KT-1000 side-to-side difference, Lachman test, range of motion (ROM), the subjective Knee score of the International Knee Documentation Committee (IKDC), Lysholm Knee score, and Tegner activity grade score were evaluated preoperatively and at the minimum 1-year follow-up visit.
    RESULTS: A total of 16 participants met the inclusion criteria. They had a mean age of 12.6 years (range, 9-16 years); mean time to surgery, 6.9 days (range, 2-13 days) and had a minimum of 12 months clinical follow-up (mean, 25.4 months; range, 12-36 months) after surgery. Postoperative radiographs and MRI showed no injury to the epiphyseal plate, optimal reduction immediately after the operation, and bone union within three months in all patients. All of the following showed significant improvements (pre- vs. postoperatively): mean KT-1000 side-to-side difference (8.6 vs. 1.5; p < 0.05), Lachman tests (2 grade 9 and 3 grade 7 vs. 0 grade 12 and 1 grade 4; p < 0.05), IKDC subjective score (48.3 vs. 95.0; p < 0.05), mean Lysholm score (53.9 vs. 92.2; p < 0.05), mean Tegner activity score (3.2 vs. 8.3; p < 0.05) and mean ROM (42.9°vs 133.1°; p < 0.05).
    CONCLUSIONS: Arthroscopic reduction and modified suture bridge fixation for ACL tibial avulsion fracture is a dependable and recommended treatment that can effectively restore the stability and function of the knee and is worthy of clinical promotion.
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  • 文章类型: Journal Article
    方法:一名12岁女孩在足球比赛中跌倒后出现严重的右肘疼痛,导致骨三头肌撕脱伤和非移位的II型Salter-Harris桡骨颈骨折。患者通过缝合锚钉固定成功进行了开放修复,导致功能完全返回并返回到以前的活动。
    结论:及时准确地诊断和治疗移位的肱三头肌袖撕脱伤至关重要,可以获得良好的患者预后并恢复到以前的功能水平。这种独特的病例有助于儿科人群中这种罕见疾病的诊断和管理。
    METHODS: A 12-year-old girl presented with significant right elbow pain following a fall during soccer which caused an osseous triceps avulsion injury and nondisplaced type II Salter-Harris radial neck fracture. The patient was treated with successful open repair utilizing suture anchor fixation, resulting in full return of function and return to previous activities.
    CONCLUSIONS: Timely and accurate diagnosis and treatment of displaced triceps sleeve avulsion injuries is critical and can result in excellent patient outcomes and return to previous functional level. This unique case contributes to the diagnosis and management of this rare condition in pediatric populations.
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  • 文章类型: Journal Article
    目的:比较后内侧入路切开复位空心钉和螺纹铆钉内固定与关节镜下Endobutton钢板内固定治疗后交叉韧带撕脱性骨折的临床疗效。
    方法:回顾性分析2020年7月至2021年12月38例后交叉韧带撕脱骨折患者的临床资料。分为切开复位内固定组(后内侧入路空心锚钉系统固定)和关节镜下固定组(关节镜下Endobutton带环形钢板固定)。切开复位内固定组20例,包括16名男性和4名女性,年龄在26至74岁之间,平均(42.9±18.8)岁;左侧13例,右侧7例;根据Meyers-McKeever骨折分类分为Ⅱ型12例,Ⅲ型8例;后抽屉试验分为Ⅱ级14例,Ⅲ级6例。关节镜下固定组18例,其中男性11例,女性7例;年龄24至70岁,平均(53.5±13.4)岁;左侧11例,右侧7例;根据Meyers-McKeever骨折分类,分为Ⅱ型10例,Ⅲ型8例;后抽屉试验为Ⅱ级11例,Ⅲ级7例。操作时间,失血,比较两组即刻复位质量。膝关节运动范围,膝后抽屉测试,和国际膝关节文献委员会(IKDC)评分,术后6个月比较KT2000稳定性评价及膝关节Lysholm功能评分。
    结果:所有患者均获随访8~16个月,平均(12.3±1.9)个月。无切口感染等并发症,骨折不愈合或不愈合,发生内固定松动。术后6个月膝关节撕脱性骨折达到影像学愈合标准。切开复位内固定组手术时间和术中出血量分别为(56.4±7.1)min和(63.2±10.2)ml。关节镜固定组(89.9±7.4)min,(27.7±8.7)ml,分别,两组比较差异有统计学意义(P<0.05)。即刻还原质量差异无统计学意义(χ2=0.257,P=0.612),术后6个月膝关节活动度(t=0.492,P=0.626),膝关节后抽屉试验(χ2=0.320,P=0.572),膝关节IKDC分级(χ2=0.127,P=0.938),KT2000稳定性评价(χ2=0.070,P=0.791),两组膝关节Lysholm功能评分(t=0.092,P=0.282)。
    结论:后内侧入路空心锚固系统内固定和关节镜下Endobutton环形钢板内固定治疗后交叉韧带胫骨咬合撕脱性骨折均能取得满意的临床效果。关节镜手术出血少,而且比传统的切口手术具有更长的学习曲线和更长的手术时间。外科医生需要根据患者的临床情况和自己的手术倾向做出选择。
    OBJECTIVE: To compare clinical effect between open reduction and fixation with cannulated screw and threaded rivet via posteromedial approach versus arthroscopic Endobutton plate fixation in treating posterior cruciate ligament avulsion fractures.
    METHODS: Clinical data of 38 patients with posterior cruciate ligament avulsion fractures from July 2020 to December 2021 were analyzed retrospectively, and divided into open reduction and internal fixation group (posterior medial approach hollow anchor system fixation) and arthroscopic fixation group (Endobutton with loop plate fixation under arthroscopy). There were 20 patients in open reduction and internal fixation group, including 16 males and 4 females, aged from 26 to 74 years old with an average of (42.9±18.8) years old;13 patients on the left side and 7 patients on the right side;12 patients were classified to typeⅡand 8 patiens with type Ⅲ according to Meyers-McKeever fractures classification;14 patients were gradeⅡand 6 patients were grade Ⅲ in back drawer test. There were 18 patients in arthroscopic fixation group, including 11 males and 7 females;aged from 24 to 70 years old with an average of (53.5±13.4) years old;11 patients on the left side and 7 patients on the right side;10 patients were classified to typeⅡand 8 patiens with type Ⅲ according to Meyers-McKeever fractures classification;11 patients were gradeⅡand 7 patients were grade Ⅲ in back drawer test. Operation time, blood loss, and quality of immediate reduction were compared between two groups. Knee range of motion, knee back drawer test, and International Knee Documentation Committee(IKDC) grading, KT2000 stability evaluation and Lysholm function score of knee joint were compared at 6 months after operation.
    RESULTS: All patients were followed up for 8 to 16 months with an average of (12.3±1.9) months. There were no complications such as incision infection, fracture malunion or non-union, and internal fixation loosening occurred. The avulsion fractures of knee joint were reached to imaging healing standard at 6 months after operation. Operation time and blood loss in open reduction and internal fixation group were (56.4±7.1) min and (63.2±10.2) ml, while (89.9±7.4) min and (27.7±8.7) ml in arthroscopic fixation group, respectively, and had significant difference between two groups (P<0.05). There were no differences in immediate reduction quality (χ2=0.257, P=0.612), knee joint range of motion at 6 months after opertaion (t=0.492, P=0.626), knee joint rear drawer test ( χ2=0.320, P=0.572), IKDC classification of knee joint (χ2=0.127, P=0.938), KT2000 stability evaluation (χ2=0.070, P=0.791), and knee Lysholm function score (t=0.092, P=0.282) between two groups.
    CONCLUSIONS: Posterior medial approach with hollow anchoring system fixation and arthroscopic Endobutton with loop plate fixation for the treatment of posterior cruciate ligament tibial occlusion avulsion fracture could achieve satisfactory clinical results, and arthroscopic surgery has less bleeding, but also has a longer learning curve and longer operation time than traditional incision surgery. The surgeon needs to make a choice according to clinical situation of patient and their own surgical inclination.
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  • 文章类型: Journal Article
    背景:前交叉韧带(ACL)胫骨撕脱骨折是一种罕见的损伤,这通常发生在有交通事故或运动伤害的成年人身上。手术干预是常见的治疗方法,它们可以恢复膝关节功能,帮助恢复正常生活。在这项研究中,我们描述了关节镜下改良缝合桥固定技术治疗ACL胫骨撕脱性骨折的可行性和治疗效果。
    方法:这项回顾性研究回顾了2020年1月至2022年5月的数据。收集了18例ACL胫骨撕脱性骨折患者(男10例,女8例)的数据,并接受了关节镜下改良的缝合桥固定技术。该研究分析了术中失血的手术数据,操作时间,住院,骨折愈合时间,和视觉模拟量表(VAS)。使用前抽屉试验对膝关节进行功能评估,Lysholm膝关节评分量表,国际膝关节文献委员会(IKDC)和膝盖的运动范围(ROM)。
    结果:18例患者均获12~20个月随访,平均15.22±1.96个月。术中失血量约为15-40mL,平均25.78±6.19mL。手术时间为65-85分钟,平均74.89±4.86分钟。患者住院3-5天,平均3.89±0.76天。平均骨折愈合时间为术后8-12周,平均9.22±1.7周。所有切口均为I级愈合,无感染。没有内固定失败,神经血管损伤,下肢深静脉血栓形成。所有患者的前抽屉试验均为阴性。在最后的后续行动中,平均VAS评分为0~3分,平均1.56±0.71分。受伤膝关节的Lysholm评分为89-96,平均为92.50±2.50;IKDC评分为88-93,平均为90.44±1.89;膝关节ROM为110-126°,平均值为120.67°±4.31°。
    结论:结果表明,关节镜下改良的缝线桥固定技术可以为ACL胫骨止点撕脱骨折提供可靠的固定和良好的临床效果。这是一个简单的,微创,有效,和临床上适用的ACL胫骨撕脱骨折的手术方法。
    BACKGROUND: Anterior cruciate ligament (ACL) tibial avulsion fracture is a rare injury, which usually happens in adults with traffic accidents or sports injuries. Surgery interventions are common treatment methods, they can restore knee function and help to return to normal life. In this study, we described an arthroscopic modified suture bridge fixation technique for ACL tibial avulsion fractures and explored the feasibility and therapeutic effects.
    METHODS: This retrospective study reviewed data from January 2020 to May 2022. Data were collected on 18 patients (10 males and 8 females) with ACL tibial avulsion fractures and underwent arthroscopic modified suture bridge fixation technique. The study analyzed surgical data about intraoperative blood loss, operation time, hospital stay, fracture healing time, and visual analog scale (VAS). Functional evaluation of the knee joint was performed using the anterior drawer test, Lysholm knee scoring scale, International Knee Documentation Committee (IKDC), and knee range of motion (ROM).
    RESULTS: All 18 patients were followed up between 12 and 20 months, with an average of 15.22 ± 1.96 months. The intraoperative blood loss was approximately 15-40 mL, averaging 25.78 ± 6.19 mL. The operation time was 65-85 min, with a mean of 74.89 ± 4.86 min. The hospital stay of patients was 3-5 days, with a mean of 3.89 ± 0.76 days. The mean fracture healing time was 8-12 weeks after surgery, with a mean of 9.22 ± 1.7 weeks. All incisions healed grade I without infection. There were no internal fixation failures, neurovascular injuries, and lower extremity deep venous thrombosis. The anterior drawer test was negative in all patients. At the final follow-up, the mean VAS score was 0-3, averaging 1.56 ± 0.71. The Lysholm score of the injured knee was 89-96, with an average of 92.50 ± 2.50; the IKDC score was 88-93, with an average of 90.44 ± 1.89; the knee ROM was 110-126°, with an average of 120.67° ± 4.31°.
    CONCLUSIONS: Results demonstrated that the modified suture bridge fixation technique under arthroscope could provide reliable fixation and favorable clinical effects for ACL tibial avulsion fractures. This is a simple, minimally invasive, effective, and clinically applicable surgical method for ACL tibial avulsion fracture.
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  • 文章类型: Systematic Review
    目的:对于不同入路的胫骨隆突撕脱骨折,理想的手术治疗仍存在争议,整个文献报道的固定方法和术后方案。当前的系统评价和荟萃分析旨在比较不同的方法,胫骨隆突骨折的固定方法和术后治疗方案。
    方法:根据PRISMA指南进行系统评价。使用PubMed进行了搜索,MEDLINE和CINAHL数据库。使用的关键词是“前交叉韧带”,“胫骨棘”或“胫骨隆起”和“骨折”或“撕脱”。包括所有报告胫骨隆突骨折手术结果的原始人体研究。进行个体患者数据荟萃分析。
    结果:纳入了48项研究,共1367例患者。关节镜固定在前抽屉试验(p=0.018)和拉赫曼试验(p=0.042)方面产生了显著更大的稳定性,与开放固定相比,尽管枢轴移位测试没有显着差异。在功能评分和活动方面没有显着差异,包括Lysholm得分,IKDC主观评分,Tegner得分并返回运动。与螺钉固定相比,缝线固定的稳定性显着增加,就前抽屉试验(p=0.001)和拉赫曼试验(p=0.001)而言,尽管枢轴移位测试没有发现显著差异。缝合线固定也注意到主观评分和恢复活动明显更好,就Lysholm评分而言(p=0.008),IKDC主观评分(p=0.001)和Tegner评分(p=0.001),尽管没有发现重返运动的显着差异。
    结论:关节镜和缝线固定与开放和螺钉固定相比,具有明显的优越性。与开放固定相比,关节镜固定显着改善了膝关节的稳定性。尽管在功能膝关节评分和恢复活动方面没有发现显着差异。与螺钉固定相比,缝线固定显着改善了膝盖和功能性膝盖螺钉的稳定性。
    OBJECTIVE: The ideal surgical management for tibial eminence avulsion fractures remains controversial with varying approach, methods of fixation and post-operative regimes reported throughout literature. The current systematic review and meta-analysis aims to compare between the different approaches, methods of fixation and post-operative regimes for tibial eminence fractures.
    METHODS: The systematic review was conducted according to PRISMA guidelines. A search was conducted using PubMed, MEDLINE and CINAHL databases. The keywords used were \"anterior cruciate ligament\", \"tibial spine\" or \"tibial eminence\" and \"fracture\" or \"avulsion\". All original human studies that reported the surgical outcomes of tibial eminence fractures were included. Individual patient data meta-analysis was performed.
    RESULTS: 48 studies with 1367 patients were included. Arthroscopic fixation resulted in significantly greater stability in terms of anterior drawer test (p = 0.018) and Lachman\'s test (p = 0.042), as compared to open fixation, though there was no significant difference for pivot shift test. There was no significant difference identified in functional scores and activity, including Lysholm score, IKDC subjective score, Tegner score and return to sports. Suture fixation had significantly increased stability compared to screw fixation, in terms of anterior drawer test (p = 0.001) and Lachman\'s test (p = 0.001), though no significant difference was identified for pivot shift test. Significantly better subjective scores and return to activity were also noted for suture fixation, in terms of Lysholm score (p = 0.008), IKDC subjective score (p = 0.001) and Tegner score (p = 0.001), though no significant difference was identified for return to sports.
    CONCLUSIONS: Arthroscopic and suture fixation had significantly superior outcomes when compared to open and screw fixation. Arthroscopic fixation resulted in significantly improved stability of the knee as compared to open fixation, though no significant difference was identified in terms of functional knee scores and return to activity. Suture fixation resulted in significantly improved stability of the knee and functional knee screws as compared to screw fixation.
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  • 文章类型: Journal Article
    目的:本研究的目的是分析关节镜下固定和切开复位内固定(ORIF)治疗后交叉韧带(PCL)胫骨止点撕脱性骨折的差异。
    方法:这项回顾性研究分析了在我院接受手术治疗并随访至少24个月的急性PCL胫骨撕脱骨折患者。基于性别的变量,年龄,Meyers-McKeever型,手术方法,半月板撕裂,外固定,劳动或体育,Lysholm膝盖得分,IKDC评分,和KT-1000值也被记录。采用多因素非条件逻辑回归和1:1倾向评分匹配(PSM)的Student\'st检验来去除混杂因素进行分析。
    结果:65例膝关节功能达到“良好”或更好,9个案例没有。单因素分析显示Meyers-McKeever分型(χ2=4.669,P=0.031)和手术入路(χ2=9.428,P=0.002)与功能结局相关。多因素logistic回归分析进一步证实Meyers-McKeever分型(OR=10.763,P=0.036,[95%CI1.174-98.693])和手术方式(OR=9.274,P=0.008,[95%CI1.794-47.934])是影响预后的独立危险因素。此外,PSM验证了Lysholm评分的显着差异(t=3.195,P=0.006),IKDC评分(t=4.703,P=0.000)和A-KT/H-KT(t=2.859,P=0.012)。然而,受影响侧KT-1000值(A-KT,mm,t=1.225,P=0.239)和健康侧KT-1000值(H-KT,mm,t=1.436,P=0.172)两组之间没有显着差异。Lysholm评分的病例比例,IKDC和A-KT/H-KT超过最小临床重要差异(MCID)为62.5%(20/32),62.5%(20/32)和93.75%(30/32),分别。
    结论:与ORIF相比,关节镜下PCL胫骨止点撕脱骨折治疗效果较好.
    方法:回顾性队列研究;II级。
    OBJECTIVE: The purpose of this study was to analyse the difference between arthroscopic fixation and open reduction internal fixation (ORIF) of posterior cruciate ligament (PCL) tibial avulsion fractures.
    METHODS: This retrospective study analysed patients with an acute PCL tibial avulsion fracture who underwent surgical treatment at our hospital and follow-up for at least 24 months. Variables based on sex, age, Meyers-McKeever type, surgical method, meniscus tear, external fixation, labour or sports, Lysholm knee score, IKDC score, and KT-1000 value were also recorded. Multifactor unconditional logistic regression and Student\'s t test with 1:1 propensity score matching (PSM) to remove confounding factors were used for analysis.
    RESULTS: Sixty-five cases achieved knee function graded as \"good\" or better, and 9 cases not. Single-factor analysis indicated that Meyers-McKeever type (χ2 = 4.669, P = 0.031) and surgical approach (χ2 = 9.428, P = 0.002) are related to functional outcomes. Multifactorial logistic regression analysis further confirmed that Meyers-McKeever typing (OR = 10.763, P = 0.036, [95% CI 1.174-98.693]) and surgical approach (OR = 9.274, P = 0.008, [95% CI 1.794-47.934]) are independent risk factors affecting prognosis. In addition, PSM verified significant differences in the Lysholm score (t = 3.195, P = 0.006), IKDC score (t = 4.703, P = 0.000) and A-KT/H-KT (t = 2.859, P = 0.012). However, the affected-side KT-1000 value (A-KT, mm, t = 1.225, P = 0.239) and healthy-side KT-1000 value (H-KT, mm, t = 1.436, P = 0.172) did not significantly differ between the two groups. The proportions of cases in which the Lysholm score, IKDC and A-KT/H-KT exceeded the minimal clinically important difference (MCID) were 62.5% (20/32), 62.5% (20/32) and 93.75% (30/32), respectively.
    CONCLUSIONS: Compared with ORIF, an arthroscopic approach for PCL tibial avulsion fractures achieves better results.
    METHODS: Retrospective cohort study; Level II.
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