膝关节多韧带损伤的手术治疗  

The surgical treatment of multi- ligaments injury of knee joint

作　　者：郭其勇[1] 李华德[1] 李明[1] 贾庆卫[1] 

机构地区：[1]泰山医学院附属医院,山东泰安271000

出　　处：《中国矫形外科杂志》2015年第10期892-896,共5页Orthopedic Journal of China

摘　　要：[目的]评估膝关节多韧带损伤手术治疗的技术方法与疗效。[方法]23例膝关节多韧带损伤的患者,男17例,女6例,年龄22∽57岁,其中四条韧带均损伤者2例,ACL、PCL和MCL损伤者16例,ACL、PCL和LCL损伤者5例。根据患者受伤情况分期手术治疗与一期手术治疗相结合,2例四条韧带均损伤者,手术分两期进行,一期先行内外侧副韧带修复,术后行功能锻炼8∽12周膝关节屈曲〉90°后,二期行前后交叉韧带重建。其余3条韧带损伤者一期行韧带修复和重建,术中先在关节镜下重建前后交叉韧带,然后修复内侧或外侧副韧带。前后交叉韧带损伤于关节镜下行自体或同种异体肌腱重建,内外侧副韧带损伤行带线铆钉修补。手术前后行Lachman试验、IKDC和Lysholm评分,以评估手术疗效。[结果]23例患者术后随访8∽24个月,术后6个月及12个月分别行lachman试验、Lysholm评分及IKDC 2000评分,重建后患者膝关节疼痛、肿胀、屈伸活动受限等症状明显改善,Lachman试验均为阴性,Lysholm膝关节功能评分、IKDC分级评分较重建前明显提高（P〈0.05）。[结论]重建前后交叉韧带、带线铆钉修补内外侧副韧带手术治疗膝关节多韧带损伤,能有效恢复膝关节的稳定性,改善膝关节功能,取得了良好的临床效果。[Objective]To assess the clinical techniques and results of surgical treatment for multi- ligaments injury of the knee. [Method]A total of 23 patients with multi- ligaments injury of knee joint were surgically treated（17 males,6 females,aged from 22- 57 years old）. The injuries involved four ligaments including anterior cruciate ligament（ AC L）,posterior cruciate ligament（ PCL）,medial collateral ligament（ MCL） and lateral collateral ligament（ LCL） in 2 cases,three ligaments including ACL,PCL,MCL in16 cases,three ligaments including ACL,PCL,LCL in 5 cases. The two patients with four ligaments injury were treated by two- stage operation. MCL and LCL were repaired in the first operation. During the second operation,ACL and PCL were reconstructed under arthroscopy after eight to twelve- week functional exercise with the range of motion（ ROM）of knee joint more than 90 degree. The patients with three ligaments injury were treated by one- stage reconstruction. MCL or LCL was repaired after the reconstruction of ACL and PCL. All the patients with ACL and PCL injury received autologous or allogeneic tendon reconstruction under arthroscopy,and the patients with MCL or LCL injury were repaired with rivet. The Lachman test,IKDC classification and Lysholm scores were performed before and after surgery to evaluate the effect of reconstruction. [Result]A total of 23 cases were followed up for 8 to 24 months. All preoperative symptoms got better apparently,such as the pain of the knee joint,swelling and limitation of range of motion. The Lachman tests were negative. IKDC Classification and Lysholm scores after reconstruction for 6 and 12 months were significantly increased when compared with that prior to surgery（ P 0. 05）. [Conclusion]The results demonstrate that reconstruction of ACL and PCL and repair of MCL and LCL with rivet can recovery the stability of knee joint,improve the function of the knee and obtain good clinical effect.

关 键 词：膝关节 多韧带损伤 分期治疗 关节镜 修复和重建 

分 类 号：R687.4[医药卫生—骨科学]