微创手术治疗O'Donoghue三联征30例临床体会  

Experience of minimally invasive surgery on 30 cases of O' Donoghue triple syndrome

作　　者：刘仕杰[1] 史福东[1] 左金增[1] 武强[1] 王雪臣[1] 马海洋[1] 李长江[1] 

机构地区：[1]唐山市人民医院骨科,063000

出　　处：《疑难病杂志》2015年第5期494-496,500,共4页Chinese Journal of Difficult and Complicated Cases

基　　金：河北省医学科学研究重点课题计划资助项目(No.20130319)

摘　　要：目的探讨早期微创手术对O'Donoghue三联征(前交叉韧带断裂合并内侧副韧带断裂和内侧半月板损伤)的治疗效果。方法回顾性分析2009年12月—2014年1月收治的30例膝关节三联损伤患者,进行关节镜下重建前交叉韧带断裂、内侧半月板损伤修复成形、内侧副韧带断裂带线锚钉固定或可吸收线缝合。术后6个月后对膝关节功能应用Lysholm评分和Tegner评分进行评估,并对其手术时间、术后引流量以及随访12个月内患者的恢复情况进行统计学分析。结果 30例患者的平均手术时间为(1.8±1.3)h,术后引流量为(205±11.8)ml,除1例患者因卧床问题出现患部麻木胀痛以外,其余均保持较好的临床情况。全部病例均获随访,随访6个月后,临床总有效率达93.3%(28/30),其中优24例(80.0%),好转4例(13.3%),无效2例(6.7%);关节稳定性良好,膝关节屈曲超过120°者28例(93.3%),2例因术后惧怕疼痛导致膝关节屈曲练习角度不足120°;术后遗留膝关节活动时疼痛2例。术后12个月后,30例患者均可进行正常的膝伸屈,且可通过膝伸屈以及外翻应力试验(0°和30°)检测。对膝关节功能进行Lysholm和Tegner评分,与术前比较差异均有统计学意义(t=12.213、15.322,12.267、13.322,P<0.01)。结论对膝关节三联伤进行早期的微创手术治疗,不仅可以将创伤降到最小,还可以在处理合并损伤的同时,恢复膝关节的稳定性和功能。Objective To investigate the effect of early minimally invasive surgery on OˊDonoghue （ anterior cruciate ligament rupture and medial collateral ligament rupture and medial meniscus） .Methods Retrospectively analyzed the data of 30 knee joint triple damage cases from December 2009 to January 2014, reconstruction of the anterior cruciate ligament rup-ture, medial meniscus repair forming, medial collateral ligament rupture suture anchors fixation or absorbable suture arthro-scopic were performed.6 months later, Lysholm score and Tegner score were used to evaluate the function of knee joint, and analyzed the restoration of the operation time, postoperative drainage during 12 months of follow-up.Results The average operation time of these 30 patients was （1.8 ±1.3） h, postoperative drainage was （205.0 ±11.8） ml, except 1 patient had affected part numbness pain due to lying bed problems, the rest were maintained in good clinical condition.All the patients were followed up, for 6 months, the clinical total effective rate was 93.3%（28/30）, 24 cases of excellent （80.0%）, im-proved in 4 cases （13.3%）, invalid in 2 cases （6.7%）;the joint stability was good, 28 cases with more than 120 degrees of knee flexion （93.3%） , 2 cases’ postoperative knee flexion angle less than 120 degrees due to fear the pain;postoperative left knee pain during activity in 2 cases.After follow up of 12 months, 30 patients with normal knee flexion, knee extension and flexion and the valgus stress test （0＆#176;and 30＆#176;） were all passed.Compared with the preoperative, Lysholm and Tegner score of knee joint function were improved with statistics significance differences （ t =12.213, t =15.322, t =12.267, t =13.322, P〈0.01）.Conclusion Early minimally invasive surgical treatment for knee joint triple injury not only can reduce the trauma to a mini-mum level, but also help to stablility and recovery the function of knee joint in processing of repairing the trauma.

关 键 词：膝关节 前交叉韧带 内侧半月板 内侧副韧带 微创手术 关节镜 

分 类 号：R687.4[医药卫生—骨科学]