同期与分期重建修复膝关节前交叉韧带合并内侧副韧带损伤的临床疗效比较  

Clinical Efficacy of One-stage and Two-stage Reconstruction Repair of Knee Joint Anterior Cruciate Ligament and Medial Collateral Ligament Injury

作　　者：赫明亮 李忠 

机构地区：[1]西南医科大学附属医院骨关节外科,四川泸州646000

出　　处：《实用骨科杂志》2017年第6期507-510,共4页Journal of Practical Orthopaedics

摘　　要：目的比较同期与分期重建修复膝关节前交叉韧带(anterior cruciate ligament,ACL)合并内侧副韧带(medial collateral ligament,MCL)损伤的临床疗效。方法 2012年1月至2014年7月收治27例ACL合并MCLⅡ度急性损伤患者,其中男17例,女10例;年龄18~55岁,平均(34.5±5.6)岁;左膝16例,右膝11例。随机分为A、B两组,A组(15例)行关节镜下自体腘绳肌腱ACL重建术,MCL止点撕脱骨折锚钉修复术。B组(12例)采用I期保守治疗MCL损伤,Ⅱ期行自体腘绳肌腱ACL重建术。术后随访12~24个月,平均10.3个月,根据应力位内侧间隙开大程度和Lachman试验进行膝关节稳定性评分,采用IKDC和Lysholm膝关节功能评分对术前及末次随访的患者膝关节功能进行评估。结果 A、B两组患者术前应力位内侧间隙开大程度均为Ⅱ级,Lachman试验均为Ⅲ级。术前IKDC及Lysholm膝关节功能评分分别为A组(45.36±4.12)分和(43.23±3.55)分,B组(45.31±1.50)分和(44.10±2.27)分。A、B两组患者末次随访时应力位内侧间隙开大程度为A组Ⅰ级10例,Ⅱ级5例;B组12例全部Ⅰ级。Lachman试验A组阴性13例,Ⅰ级2例;B组阴性11例,Ⅰ级1例。IKDC及Lysholm膝关节功能评分分别为A组(87.54±5.24)分和(86.73±6.99)分,B组(94.11±3.38)分和(92.32±3.43)分。A、B两组比较差异有统计学意义(P<0.05)。结论对于膝关节ACL合并MCL损伤,B组行Ⅰ期MCL保守治疗,Ⅱ期关节镜下ACL重建修复,术后膝关节功能、稳定性评分及膝关节活动度均优于A组同期ACL重建和MCL修复。Objective To compare the clinical efficacy of one-stage and two-stage reconstruction repair of knee joint anterior cruciate ligament and medial collateral ligament injury.Methods In January 2012 to July 2014,27 cases of ACL combined with Ⅱ MCL degree of acute injury were randomly divided into A and B groups.Group A （n=15） underwent arthroscopic autologous hamstring ACL reconstruction,MCL avulsion fracture of anchor repair.Group B （n=12） underwent brace fixation of the affected limb.Patients were followed up for 12 to 24 months,with an average of 18 months,according to the stress inside the gap open degree and Lachman test score of knee stability by IKDC and Lysholm knee function was assessed before surgery and at the end of follow-up of patients with knee joint function score. Results A,B two groups of patients with preoperative stress level medial clearance were class Ⅱ,Lachman test were grade Ⅲ.Preoperative IKDC and Lysholm knee function scores were （45.36±4.12） and （43.23±3.55） in group A,（45.31±1.50） and （44.10±2.27） in group B.At the time of the last follow-up the stress level medial clearance were degree Ⅰ in 10 cases,grade Ⅱ in 5 cases in group A;12 cases of group B were all grade Ⅰ.There were 13 Lachman test negative casesingroup A,including 2 cases of grade Ⅰ;and 11 negative casesin group B,including1 case of grade Ⅰ.IKDC and Lysholm score of knee joint function were （87.54±5.24） and （86.73±6.99） respectively in group A and were （94.11±3.38） and （92.32±3.43） ingroup B.The differenceswere statistically significant （P〈0.05）.Conclusion For knee joint ACL combined with MCL injury,conservative treatment of group B underwent one-stage MCL,phase Ⅱ arthroscopic ACL reconstruction,postoperative knee function and stability grading knee joint activities were better than A group over the same period of reconstruction of ACL and MCL repair.

关 键 词：前交叉韧带 内侧副韧带 Ⅰ期治疗 分期治疗 膝关节 

分 类 号：R684[医药卫生—骨科学]