关节镜下韧带重建治疗外伤性膝关节脱位合并多发韧带损伤  

Arthroscopic ligament reconstruction in the treatment of traumatic knee dislocation complicated with multiple ligament injury

作　　者：曹恺祺 曾武[2] 曾宇晴[1] 朱绍瑜 刘易扬 黄艳峰 赵忠胜 CAO Kaiqi;ZENG Wu;ZENG Yuqing;ZHU Shaoyu;LIU Yiyang;LIN Jie;HUANG Yanfeng;ZHAO Zhongsheng(Zhejiang Provincial Tongde Hospital,Hangzhou 310012,China;Suichang County People's Hospital in Zhejiang Province,Suichang 323300,China;Institute of Integrated Chinese and Western Medicine,Fujian University of Traditional Chinese Medicine,Fuzhou 350122,China)

机构地区：[1]浙江省立同德医院,浙江杭州310012 [2]浙江省遂昌县人民医院,浙江遂昌323300 [3]福建中医药大学中西医结合研究院,福建福州350122

出　　处：《中国现代医生》2020年第5期80-83,I0001,共5页China Modern Doctor

基　　金：浙江省中医药科技计划项目(2016ZB006)。

摘　　要：目的探讨关节镜下韧带修复或重建治疗外伤性膝关节脱位合并多发韧带损伤的疗效。方法回顾性分析2010年6月~2016年12月收治的14例关节镜下韧带修复或重建治疗的外伤性膝关节脱位病例,其中KD-Ⅰ型4例,KD-Ⅱ型6例,KD-Ⅲ型4例(改良Sehenck分型)。4例(KD-Ⅱ型2例,KD-Ⅲ型2例)合并腘动脉损伤者先行血管探查吻合及侧方结构修复术,6周后重建交叉韧带;10例(KD-Ⅰ型4例,KD-Ⅱ型4例,KD-Ⅲ型2例)行一期关节镜下交叉韧带重建术+侧副韧带重建或修复术。随访时行膝关节体格检查、VAS评分、Lysholm评分及关节活动度等,以评价临床疗效。结果全部病例随访18~42个月,平均24个月。末次随访时VAS评分(1.6±0.3)分,Lysholm膝关节评分(81.6±12.2)分,关节活动度(120.5°±18.6°),与术前比较均有改善(P<0.05)。3例(21.4%,3/14)残留膝关节不稳定:抽屉试验(+)3例,外翻应力试验(+)1例。2例出现关节僵硬。结论KD-Ⅰ型、KD-Ⅱ型外伤性膝关节脱位,应待肿胀消退后,一期关节镜下重建交叉韧带;KD-Ⅲ型外伤性膝关节脱位应选择分期手术,肿胀消退后先修复或重建侧方结构,待炎症消退、关节囊及侧方结构愈合后,再行二期交叉韧带重建。Objective To explore the efficacy of arthroscopic ligament repair or reconstruction in the treatment of traumatic knee dislocation complicated with multiple ligament injury.Methods A retrospective analysis was carried out on 14 patients with traumatic knee dislocation who were admitted and treated with arthroscopic ligament repair or reconstruction from June 2010 to December 2016.There were 4 cases of KD-Ⅰtype,6 cases of KD-Ⅱtype,and 4 cases of KD-Ⅲtype(modified Sehenck type).4 patients(2 cases of KD-Ⅱtype and 2 cases of KD-Ⅲtype)who were complicated with radial artery injury were given vascular exploration anastomosis and lateral structure repair,and the cruciate ligament was reconstructed after 6 weeks.10 patients(4 cases of KD-Ⅰtype,4 cases of KD-Ⅱtype,2 cases of KD-Ⅲtype)were given stage I arthroscopic cruciate ligament reconstruction+lateral collateral ligament reconstruction or repair.At the time of follow-up,knee joint physical examination was carried out,and VAS score,Lysholm score and joint mobility were determined,so as to evaluate the clinical efficacy.Results All cases were followed for 18 to 42 months,with an average of 24 months.At the last follow-up,the VAS Score was(1.6±0.3),the Lysholm knee score was(81.6±12.2),and the joint mobility was(120.5°±18.6°).There was improvement compared with those before surgery(P<0.05).There were 3 cases(21.4%,3/14)with residual knee instability:3 cases receiving drawer test(+)and 1 case receiving valgus stress test(+).Joint stiffness was seen in 2 cases.Conclusion KD-Ⅰand KD-Ⅱtype traumatic knee dislocation should be given stage I arthroscopic reconstruction of the cruciate ligament after swelling subsides.KD-Ⅲtype traumatic knee dislocation should be given staged surgery,and the lateral structure should be repaired or reconstructed after the swelling subsides.The stageⅡreconstruction of cruciate ligament should be performed after the inflammation subsides,and the joint capsule and the lateral structure heals.

关 键 词：外伤性膝关节脱位 关节镜 韧带重建 膝关节功能 

分 类 号：R687[医药卫生—骨科学]