目的 评估膝关节后侧微创入路治疗后交叉韧带(PCL)胫骨止点撕脱骨折的临床疗效、生物力学稳定性及瘢痕恢复情况。方法 采用回顾性队列研究设计,收集2021-06至2025-04无锡市第八人民医院骨科收治的PCL胫骨止点撕脱骨折患者45例,其中Meyers-Mckeever分型Ⅱ型23例、Ⅲ型22例,依据手术方案分为观察组(膝关节后侧微创入路,23例)和对照组(传统倒L形入路,22例)。比较两组手术相关指标(切口长度、手术时间、术中出血量、住院时间)、术后并发症、骨性愈合时间、不同时间点膝关节活动度(ROM)、疼痛视觉模拟评分(VAS)、吕斯霍姆评分(Lysholm评分)、泰格纳尔评分(Tegner评分)、国际膝关节文献委员会评分(IKDC)、瘢痕满意度评分(VSS)及健康调查简表(SF-36)生活质量评分,结合后抽屉试验评估生物力学稳定性,并进行亚组分析。结果 所有患者随访12～24个月,平均(16.57±3.58)个月。观察组切口长度、手术时间、术中出血量、住院时间均优于对照组,差异有统计学意义(P＜0.05)。观察组术后1、3、7 d VAS评分低于对照组,差异有统计学意义(P＜0.05)。对照组出现3例脂肪液化(发生率13.64%),观察组无并发症。两组骨性愈合时间差异无统计学意义。观察组术后1个月ROM、末次随访Tegner评分、IKDC评分、SF-36评分均优于对照组,差异有统计学意义(P＜0.05);术后6个月观察组VSS评分为(1.95±0.74)分,低于对照组的(4.09±1.05)分,差异有统计学意义(P＜0.05)。观察组术后6个月后抽屉试验Ⅰ度稳定性占比为95.65%,高于对照组的77.27%。亚组分析显示,不同分型及年龄层患者均能从改良术式中获益。结论 膝关节后侧微创入路治疗PCL胫骨止点撕脱骨折,在创伤控制、疼痛缓解、住院周期、功能恢复、生物力学稳定性及瘢痕美观度方面均具显著优势,并发症发生率更低,是安全高效的个体化治疗方案。

Objective To evaluate the clinical efficacy, biomechanical stability, and scar recovery of minimally invasive posterior approach for the treatment of posterior cruciate ligament (PCL) avulsion fractures at the tibial insertion. Methods A retrospective cohort study design was adopted. A total of 45 patients with PCL avulsion fractures at the tibial insertion (23 cases of type Ⅱ and 22 cases of type Ⅲ according to the Meyers-Mckeever classification) admitted to the Department of Orthopedics of the Eighth People’s Hospital of Wuxi from June 2021 to April 2025 were included. According to the surgical plan, the patients were divided into an observation group (minimally invasive posteromedial approach, 23 cases) and a control group (traditional inverted L approach, 22 cases). The surgical-related indicators (incision length, operation time, intraoperative blood loss, hospital stay), postoperative complications, bone healing time, knee joint range of motion (ROM) at different time points, visual analogue scale (VAS) for pain, Lysholm score, Tegner score, International Knee Documentation Committee (IKDC) score, scar satisfaction score (VSS), and SF-36 quality of life score were compared between the two groups. Biomechanical stability was evaluated by the posterior drawer test, and subgroup analysis was conducted. Results All patients were followed up for 12 to 24 months, with an average of (16.57±3.58) months. The observation group had significantly better incision length, operation time, intraoperative blood loss, and hospital stay than the control group, and the differences were statistically significant (P<0.05). The VAS scores of the observation group at 1, 3, and 7 days after surgery were lower than those of the control group, with statistically significant difference(P<0.05). Three cases of fat liquefaction occurred in the control group (incidence rate of 13.64%), while there were no complications in the observation group. The difference in complication rates between the two groups was statistically significant. There was no difference in bone healing time between the two groups. The ROM at 1 month after surgery, the Tegner score, IKDC score, and SF-36 score at the last follow-up in the observation group were better than those in the control group, with statistically significant difference (P<0.05); the VSS score at 6 months after surgery in the observation group (1.95±0.74) was lower than that in the control group (4.09±1.05) , and the difference was statistically significant (P<0.05). The proportion of grade I stability in the posterior drawer test at 6 months after surgery in the observation group was 95.65%, significantly higher than 77.27% in the control group. Subgroup analysis showed that patients of different types and age groups could benefit from the modified surgical approach. Conclusions The minimally invasive posterior approach for the treatment of PCL avulsion fractures at the tibial insertion has significant advantages in trauma control, pain relief, hospital stay, functional recovery, biomechanical stability, and scar aesthetics, with a lower complication rate, which is a safe and efficient individualized treatment option.