急性膝关节后内侧角损伤  

Acute injury of posteromedial corner of the knee

作　　者：孙磊[1] 宁志杰[1] 田敏[1] 宁廷民[1] 魏嵬[1] 张红[1] 马清元[1] 高加智[1] 

机构地区：[1]解放军第88医院骨科,山东泰安271000

出　　处：《中国矫形外科杂志》2005年第20期1528-1531,F0003,共5页Orthopedic Journal of China

摘　　要：[目的]探讨急性膝关节后内侧角损伤的诊断与治疗。[方法]自2000年12月～2004年1月收治急性膝关节损伤12例(12膝),病人均表现为伸膝位和屈膝30°位外翻应力试验阳性和伤膝旋转不稳定,于伤后2～12d接受了关节镜检查及内侧开放探查,12膝均有后内侧角损伤和内侧副韧带损伤,4膝伴前、后交叉韧带断裂;2膝伴前交叉韧带断裂;4膝伴后交叉韧带断裂。12膝均一期手术修复后内侧角和内侧副韧带。8周后,12例病人中8人接受二期关节镜下手术,前交叉韧带重建3例,前后交叉韧带联合重建3例,后交叉韧带重建2例。[结果]一期手术后8周评估表明12膝均恢复内后侧稳定性,伸膝位和屈膝30°位外翻应力试验均为阴性。12例病人随访10～20个月,平均12.0±3.2个月,Lysholm膝关节功能评分87.08±6.28。IKDC综合评定正常(A级)4例,接近正常(B级)7例,异常(C级)1例。[结论]急性膝关节后内侧角损伤见于较高能量损伤,多为复合损伤,表现为伸膝位和屈膝30°位外翻应力试验阳性和伤膝旋转不稳定。应一期手术修复后内侧角和内侧副韧带,二期酌情重建交叉韧带。[ Objective] To explore diagnosis and treatment of acute injury of posteromedial comer of the knee. [ Method] From December 2000 to January 2004, 12 patients （12 knees） with acute knee injury were admitted into hospital. Abduction stress test and rotary test were positive in all affected knees. Arthroscopy examination, open explore of medial side of the knee were performed from 2 days to 12 days after injury, in the operation posteromedial comer rupture and medial collateral ligament tear were fund in all knees, combined anterior cruciate ligament and posterior cruciate ligament tears in 4 knees, combined anterior cruciate ligament tear in 2 knees, and combined posterior cruciate ligament tear in 4 knees, in this stage procedure, posteromedial comer rupture and medial collateral ligament tear were repaired in anatomical position and physiological tension in all knees. Based on the instability of affected knee at 8 weeks after first operation, 8 knees of them underwent second arthroscopic procedure, 2 knees of anterior cruciate ligament reconstruction, 4 knees of combined anterior cruciate ligament and posterior cruciate ligament reconstruction and 2 knees of posterior cruciate ligament reconstruction. [ Result ] Evaluation at 8 weeks after first operation showed satisfactory recovery of medial and posteromedial stability in all knees, presented negative results in abduction stress tests at full extension and 30° flexion of the knee. All patients were followed up from 10 to 20 months with an average of 12.0± 3.2 months. Lysholm score was 87.08 ± 6.28, IKDC was normal （grade A） in 4 knees, nearly normal （grade B） in 7 knees and abnormal （grade C） in 1 knee. [ Conclusion] Acute posteromedial comer injury is often caused by high energy damage, usually combined with other ligaments injury, appeared positive result of abduction stress tests in full extension and 30°flexion of the knee, and rotatory instabilities. The first stage operation to repair posteromedial comer and medial collateral ligament,

关 键 词：膝关节 后内侧角 内侧副韧带 关节镜 前交叉韧带 后交叉韧带 半月板 急性膝关节损伤 内侧副韧带损伤 节后 

分 类 号：R684[医药卫生—骨科学] R686.5[医药卫生—外科学]