分期治疗外伤性膝关节脱位合并多韧带损伤的疗效观察  

EFFECTIVENESS OF TRAUMATIC DISLOCATION OF KNEE JOINT COMBINED WITH MULTIPLE LIGAMENT INJURIES TREATED BY STAGES

作　　者：陈志伟[1] 刘春磊[1] 杨乐忠[1] 戴祝[1] 曹盛俊[1] 

机构地区：[1]南华大学第一附属医院骨科湖南衡阳,421001

出　　处：《中国修复重建外科杂志》2011年第2期225-228,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的观察分期治疗外性伤膝关节脱位合并多韧带损伤的临床疗效。方法 2005年6月-2008年11月,收治13例外伤性膝关节脱位合并多韧带损伤患者。男9例,女4例;年龄18～54岁,平均30.7岁。致伤原因:运动伤8例,交通事故伤2例,高处坠落伤2例,扭伤1例。左侧3例,右侧10例。受伤至入院时间6 h～2 d,平均9 h。8例前交叉韧带(anterior cruciate ligament,ACL)、后交叉韧带(posterior cruciate ligament,PCL)及内侧副韧带(medial collateral ligament,MCL)损伤,3例ACL、PCL及外侧副韧带(lateral collateral ligament,LCL)损伤,2例ACL、PCL、MCL及LCL损伤。10例外翻应力试验为++～+++,5例内翻应力试验为++～+++;13例前、后抽屉试验均为阳性,Lachman试验为++～+++。一期手术修复PCL、MCL、LCL及半月板,术后固定3～4周后开始功能锻炼,4～6个月后膝关节活动范围良好且存在前方不稳时二期于关节镜下重建ACL。结果两次手术后切口均Ⅰ期愈合,无感染及骨筋膜室综合征等并发症发生。患者均获随访,随访时间12～60个月,平均36个月。一期术后4周2例出现关节腔积液,经穿刺抽吸后缓解,其余患者均未出现膝关节不适。二期术后3个月1例外翻应力试验++,1例为+;1例内翻应力试验为+;1例Lachman试验++,1例为+;其余患者各试验均为阴性。二期术后12个月患膝关节屈曲达100～135°,平均123.4°;伸直达0～4°,平均2.3°。根据Lysholm膝关节功能评分标准评定:获优9例,良2例,可2例,优良率84.6%。结论分期治疗外伤性膝关节脱位合并多韧带损伤可获得较好的临床效果。Objective To observe the effectiveness of traumatic dislocation of the knee joint combined with multiple ligament injuries treated by stages.Methods Between June 2005 and November 2008,13 cases of traumatic dislocation of the knee joint combined with multiple ligament injuries were treated by stages,including 9 males and 4 females with an average age of 30.7 years（range,18-54 years）.The dislocations were left knee in 3 cases and right knee in 10 cases.The causes of injury were sports injury in 8 cases,traffic accident injury in 2 cases,falling from height injury in 2 cases,and sprain injury in 1 case.The average time from injury to hospitalization was 9 hours（range,6 hours to 2 days）.Anterior cruciate ligament（ACL）,posterior cruciate ligament（PCL）,and medial collateral ligament（MCL） were involved in 8 cases;ACL,PCL,and lateral collateral ligament（LCL） in 3 cases;and ACL,PCL,MCL,and LCL in 2 cases.The valgus stress testing results of 10 knees were ＋＋ to ＋＋＋;the varus stress testing results of 5 knees were ＋＋ to ＋＋＋;all knees showed positive in the anterior or the posterior drawer test and ＋＋ to ＋＋＋ in Lachman test.The nerve,vessel,MCL,LCL,PCL,meniscus were repaired in the first operation.The functional exercise of knee joint was done after fixation for 3-4 weeks.During the second operation,the ACL was reconstrcted under arthroscopy after the range of motion（ROM） of knee joint was good with anterior instability of knee within 4-6 months.Results All wounds healed by first intention after two operations;no complications of infection and compartment syndrome occurred.All cases were followed up 12-60 months with an average of 36 months.Joint effusion of knee occurred in 2 cases at 4 weeks after the first operation and was cured after removal of fluid.At 3 months after the second operation,the results of valgus stress testing and Lachman test were ＋＋ in 1 case,respectively;the results of valgus stress testing,varus stress testing,and Lachman test were ＋ in

关 键 词：膝关节脱位 多韧带损伤 分期治疗 关节镜 修复重建 

分 类 号：R687.4[医药卫生—骨科学]