关节镜内固定与切开复位内固定治疗移位的胫骨侧后交叉韧带撕脱骨折：系统回顾和荟萃分析

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics Pub Date : 2025-07-01 DOI:10.1016/j.jor.2025.06.021

Rajesh Kumar Rajnish , Sandeep Kumar Yadav , Amit Srivastava , Arvind Prasad Gupta , Saurabh Gupta , Abhay Elhence

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引用次数: 0

摘要

背景：据报道，后交叉韧带（PCL）损伤的发生率在所有膝关节损伤中占3%至23%。PCL的几种损伤模式已经被描述过，包括物质内、股脱离和胫骨撕脱，其中后两种更为常见。胫骨侧移位的PCL撕脱伤需要手术固定；然而，文献中关于固定这些损伤的最佳手术入路尚无共识。目的对关节镜下和开放固定治疗胫骨侧脱位PCL撕脱骨折的疗效和并发症进行系统回顾和荟萃分析。方法：我们对PubMed、Embase、Scopus和Cochrane图书馆数据库进行了初步的电子检索，寻找评估和比较关节镜下与切开复位和固定治疗移位胫骨侧PCL撕脱性骨折疗效的比较研究。采用RevMan-5.4.1软件进行统计分析。结果本荟萃分析包括2项随机对照试验，1项前瞻性研究和7项回顾性比较研究。所有10项研究的评估显示，关节镜下固定与开放式固定在术后国际膝关节文献委员会（IKDC）评分方面无统计学差异(MD 4.43 [-0.73, 9.42；p = 0.09])， Lysholm评分(MD 2.69 [-1.07,6.45；p = 0.16]，膝关节活动度（ROM） (MD -1.08 [-2.80,0.63；p = 0.21])，并发症(OR1.75 [0.86, 3.54；P = 0.12), Tegner活动(MD 0.14 [-0.46, 0.74;p = 0.64])，胫骨后平移（PTT） (MD -0.60 [-1.51,0.31；p = 0.20，后抽屉试验（PDT），手术时间（MD 12.03） [-0.47, 24.53；P = 0.06])和住院时间。关节镜组骨折愈合率为98.77%，开放固定组为100%，愈合时间相当。与开放组相比，关节镜组的出血量明显减少。结论目前的证据表明，关节镜下或开放方法固定胫骨侧PCL撕脱性骨折的效果和并发症相当。

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Arthroscopic fixation versus open reduction and internal fixation for displaced tibial side posterior cruciate ligament avulsion fractures: A systematic review and meta-analysis

Background

The reported incidence of the posterior cruciate ligament (PCL) injury ranges from 3 to 23 % of all knee injuries. Several injury patterns of the PCL have been described, including intra-substance, femoral detachment, and tibial avulsion, of which the last two are more common. Displaced PCL avulsion injury from the tibial side requires surgical fixation; however, there is no consensus in the literature regarding the optimal surgical approach for the fixation of these injuries.

Purpose

To perform a systematic review and meta-analysis of the outcomes and complications of arthroscopic and open fixation of displaced tibial side PCL avulsion fractures.

Methods

We performed a primary electronic search across PubMed, Embase, Scopus, and Cochrane Library databases and looked for comparative studies that evaluated and compared the outcomes of arthroscopic versus open reduction and fixation of displaced tibial side PCL avulsion fractures. Statistical analyses were executed with the software RevMan-5.4.1.

Results

This meta-analysis included two RCTs, one prospective and seven retrospective comparative studies. Evaluation across all ten studies suggested no statistically significant difference for arthroscopic versus open fixation in terms of postoperative International Knee Documentation Committee (IKDC) score (MD 4.43 [-0.73, 9.42; p = 0.09]), Lysholm score (MD 2.69 [-1.07,6.45; p = 0.16], knee range of motion (ROM) (MD -1.08 [-2.80,0.63; p = 0.21]), complications (OR1.75 [0.86, 3.54; P = 0.12]), Tegner activity (MD 0.14 [-0.46,0.74; p = 0.64]), posterior tibial translation (PTT) (MD -0.60 [-1.51,0.31; p = 0.20, posterior drawer test (PDT), operating time (MD 12.03 [-0.47, 24.53; p = 0.06]), and length of hospital stay. The fracture union rate was 98.77 % in the arthroscopic group and 100 % in the open fixation group, with comparable union time. There is a significantly lesser amount of blood loss in the arthroscopic group compared to the open group.

Conclusion

Current evidence shows comparable outcomes and complications for tibial side PCL avulsion fracture fixation through arthroscopic or open methods.

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来源期刊

Journal of orthopaedics ORTHOPEDICS-

CiteScore

3.50

自引率

6.70%

发文量

202

审稿时长

56 days

期刊介绍： Journal of Orthopaedics aims to be a leading journal in orthopaedics and contribute towards the improvement of quality of orthopedic health care. The journal publishes original research work and review articles related to different aspects of orthopaedics including Arthroplasty, Arthroscopy, Sports Medicine, Trauma, Spine and Spinal deformities, Pediatric orthopaedics, limb reconstruction procedures, hand surgery, and orthopaedic oncology. It also publishes articles on continuing education, health-related information, case reports and letters to the editor. It is requested to note that the journal has an international readership and all submissions should be aimed at specifying something about the setting in which the work was conducted. Authors must also provide any specific reasons for the research and also provide an elaborate description of the results.