膝关节后内侧结构损伤合并交叉韧带断裂的手术治疗  

SURGICAL TREATMENT OF POSTEROMEDIAL CORNER INJURY COMBINED WITH CRUCIATE LIGAMENT RUPTURE OF KNEE

作　　者：陈志伟[1] 盛真[1] 戴祝[1] 

机构地区：[1]南华大学附属第一医院骨科湖南,衡阳421001

出　　处：《中国修复重建外科杂志》2013年第5期586-590,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨手术治疗膝关节后内侧结构(posteromedial corner,PMC)损伤合并前交叉韧带(anteriorcruciate ligament,ACL)、后交叉韧带(posterior cruciate ligament,PCL)断裂的方法及疗效。方法 2009年2月-2012年2月,收治15例15膝PMC损伤合并ACL、PCL断裂患者,采用缝合锚钉修复PMC联合一期或二期重建ACL、PCL治疗。男7例,女8例;年龄15～59岁,平均39岁。致伤原因:交通事故伤6例,运动伤7例,扭伤2例。受伤至手术时间3～15 d,平均7 d。外翻应力试验及前、后抽屉试验均呈阳性,关节功能障碍。ACL和PCL断裂3例,ACL断裂5例,ACL胫骨髁间嵴撕脱3例,PCL断裂4例。PMC于股骨止点撕裂9例,胫骨止点撕裂5例,体部撕裂1例。结果术后切口均Ⅰ期愈合,无并发症发生。15例均获随访,随访时间10～36个月,平均18.4个月。末次随访时14例膝关节屈、伸范围正常,1例伸直受限10°。外翻应力试验除1例呈弱阳性外,其余患者均为阴性;前、后抽屉试验均为阴性。采用改良Lysholm评分标准评定疗效:获优8例,良5例,可2例,优良率86.7%。结论膝关节PMC损伤合并ACL、PCL断裂时,早期修复PMC并合理修复重建交叉韧带能有效恢复膝关节稳定性。Objective To ,investigate the methods and effectiveness of surgical treatment tor posteromealal corner （PMC） injury combined with anterior cruciate ligament （ACL） and posterior cruciate ligament （PCL） ruptures. Methods Between February 2009 and February 2012, 15 patients （15 knees） with PMC injury combined with ACL and PCL ruptures underwent PMC repair with suture anchor and ACL and PCL reconstruction. There were 7 males and 8 females with an average age of 39 years （range, 15-59 years）. The causes of injury were traffic accident injury in 6 cases, sport injury in 7 cases, and sprain injury in 2 cases. The disease duration was 3-15 days with an average of 7 days. All patients presented positive results of anterior drawer test, posterior drawer test and valgus stress test, and dysfunction of knee joint. Of I5 cases, 3 had ACL and PCL ruptures, 5 had ACL rupture, 3 had ACL injury at the attachment point of the condyles crest, and 4 had PCL rupture; 9 had PMC tear at the femur insertion, 5 had PMC tear at the tibia insertion, and 1 had PMC tear in the body area. Results All incisions healed by first intention with no complication of infection or stiffness of knee. All cases were followed up 18.4 months on average （range, 10-36 months）. At last follow-up, 14 cases had normal knee flexion and extension ranges, but 1 case had 10~ limitation of the knee extension. Except 1 case which had weakly positive valgus stress test, the other patients showed negative results of anterior drawer test, posterior drawer test, and valgus stress test. Based on the improved Lysholm classification standard, the results were excellent in 8 cases, good in 5 cases, and fair in 2 cases; the excellent and good rate was 86.7%. Conclusion Early repair of the PMC and reasonable reconstruction of cruciate ligament can effectively restore the knee stability for patients with PMC injury combined with ACL and PCL ruptures.

关 键 词：膝后内侧结构 交叉韧带 关节镜 缝合锚钉 

分 类 号：R687.4[医药卫生—骨科学]