一期修复重建膝关节多发韧带损伤疗效观察  

EFFECTIVENESS OF ONE-STAGE REPAIR AND RECONSTRUCTION OF TRAUMATIC DISLOCATION OF KNEE JOINT COMBINED WITH MULTIPLE LIGAMENT INJURIES

作　　者：江武[1] 姚建华[1] 孔德佳[2] 孙维[3] 黄炎[3] 征华勇[3] 刘晨[3] 包先国[1] 

机构地区：[1]安徽医科大学北京军区总医院临床学院,北京100700 [2]安徽中医药大学中西医结合临床学院 [3]北京军区总医院骨科

出　　处：《中国修复重建外科杂志》2014年第7期810-813,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的 探讨关节镜下一期修复重建膝关节多发韧带损伤的临床疗效。方法 2007年3月-2009年3月,关节镜下一期修复重建膝关节多发韧带损伤25例（25膝）。男16例,女9例;年龄18～43岁,平均29.6岁。致伤原因：交通事故伤20例,高处坠落伤3例,运动伤2例。受伤至手术时间为8～14 d,平均10.5 d。膝关节Lysholm评分（37.92±3.57）分。患者均行X线片、MRI检查,提示17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,8例ACL、PCL及后外侧角（posterolateral corner,PLC）损伤。合并内侧半月板损伤5例,外侧半月板损伤8例。于关节镜下一期采用自体或同种异体肌腱重建ACL、PCL、PLC以及修复MCL。术后早期行主、被动功能锻炼。结果 术后患者切口均Ⅰ期愈合,无感染、下肢深静脉血栓形成等手术相关并发症发生。患者均获随访,随访时间24～78个月,平均50.9个月。6例术后出现关节僵硬,手法松解后,除1例仍屈曲缺失26°外,余5例屈曲缺失〈15°。末次随访时,膝关节稳定性均显著改善,前、后抽屉试验、Lachman试验以及屈曲30°内、外翻应力试验与术前比较,差异均有统计学意义（P〈0.05）。膝关节Lysholm评分达（87.84±4.85）分,显著优于术前（t=52.053,P=0.000）。国际膝关节文献委员会（IKDC）评级：16例（64%）接近正常,8例（32%）异常,1例（4%）明显异常。结论 关节镜下一期修复重建膝关节多发韧带损伤,能有效恢复膝关节功能,疗效可靠。Objective To investigate the ef ectiveness of one-stage repair and reconstruction of multiple ligament injuries of the knee under arthroscopy. Methods Between March 2007 and March 2009, 25 patients（25 knees） with multiple ligament injuries of the knee underwent one-stage repair and reconstruction under arthroscopy. Of 25 cases, 16 were male and 9 were female with an average age of 29.6 years（range, 18-43 years）. The causes of injury were trai c accident injury in 20 cases, falling injury from height in 3 cases, and sport injury in 2 cases. The time between injury and surgery was 8-14 days（mean, 10.5 days）. The preoperative Lysholm score was 37.92 ± 3.57. The X-ray i lm and MRI examinations showed that 17 patients had tears of anterior cruciate ligament（ACL）, posterior cruciate ligament（PCL）, and medial collateral ligament, and 8 patients had tears of ACL, PCL, and posterolateral corner（PLC）; 5 cases had medial meniscus injury and 7 cases had lateral meniscus injury. The ACL, PCL, and PLC were reconstructed under arthroscopy with autologous tendon or allogeneic tendon, and the MCL was repaired. Early active and passive functional exercises were done postoperatively. Results All the incisions healed by i rst intention, and there was no complications of infection and deep venous thrombosis. Twenty-i ve patients were followed up 24-78 months（mean, 50.9 months）. Six patients had knee stif postoperatively; after manipulation under anesthsia, 5 patients lost less than 15° of l exion and only 1 patient lost 26° of l exion. At last follow-up, the stability of the knee joint was signii cantly improved. There were signii cant dif erences in the anterior drawer test, posterior drawer test, Lachman test, and varus stress and valgus stress testing at 30° between at last follow-up and at preoperation（P〈0.05）. The postoperative Lysholm score was 87.84 ± 4.85, which was signii cantly better than the preoperative score（t=52.053, P=0.000）. The International Knee Documentation Committee（I

关 键 词：膝关节 多发韧带损伤 关节镜 修复重建 

分 类 号：R687.4[医药卫生—骨科学]