同种异体跟腱Y形解剖重建膝关节后外侧复合体治疗重度膝关节后外不稳定  

Anatomical posterolateral complex reconstruction in treating severe posterolateral knee instability using Y-shaped allogeneic Achilles tendon

作　　者：张辉[1] 洪雷[1] 王雪松[1] 宋关阳[1] 李岳[1] 张志军 ZHANG Hui;HONG Lei;WANG Xuesong;SONG Guanyang;LI Yue;ZHANG Zhijun(Department of Sports Medicine,Beijing Jishuitan Hospital,Beijing,100035,P.R.China)

机构地区：[1]北京积水潭医院运动医学科,北京100035

出　　处：《中国修复重建外科杂志》2022年第1期25-32,共8页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金资助项目(82172514);首都卫生发展科研专项(首发2020-1-2071)。

摘　　要：目的探讨同种异体跟腱Y形解剖重建膝关节后外侧复合体(posterolateral complex,PLC)治疗重度膝关节后外不稳定的手术技术与临床效果。方法回顾分析2013年6月—2017年8月收治且符合选择标准的12例Fanelli C型陈旧性PLC损伤伴重度膝关节后外不稳定患者临床资料。其中男9例,女3例;年龄18~57岁,中位年龄34.5岁。受伤至手术时间3~24个月,平均10.5个月。均为复合韧带损伤,采用同种异体跟腱Y形解剖重建PLC治疗。采用膝关节内翻及后向应力位X线片,测量并计算双膝外侧间隙张开距离差值及胫骨后移距离差值,以评估LCL及膝关节后向稳定性;采用屈膝30°胫骨外旋试验,计算双膝胫骨外旋角度差值,以评估膝关节外旋稳定性;采用国际膝关节文献委员会(IKDC)2000主观评分和客观评分评价患者膝关节功能。结果12例患者手术均顺利完成,术中无血管及神经损伤发生。手术时间2.5~3.5 h,平均2.7 h;术中出血量20~100 mL,平均55 mL。患者均获随访,随访时间13~41个月,平均28.1个月。末次随访时,患者双膝胫骨外旋角度差值、外侧间隙张开距离差值、胫骨后移距离差值以及IKDC2000主观评分、胫骨外旋和膝关节内翻客观评分均较术前显著改善,差异有统计学意义(P<0.05)。1例行前交叉韧带+后交叉韧带+PLC重建患者术后15个月复查发现膝关节僵直,膝关节活动范围为10°~80°,经关节镜下松解后膝关节活动范围达5°~120°,重建韧带稳定。其余患者中2例屈膝角度正常;9例存在屈膝受限5°~10°,平均6.4°,未进一步处理;均无伸膝受限。结论使用同种异体跟腱Y形解剖重建膝关节PLC能够有效治疗Fanelli C型陈旧性PLC损伤伴重度膝关节后外不稳定,显著改善膝关节稳定性。Objective To investigate the surgical technique and effectiveness of anatomical posterolateral complex(PLC)reconstruction in treating severe posterolateral knee instability using Y-shaped allogeneic Achilles tendon.Methods The clinical data of 12 patients with Fanelli type C chronic PLC injury with severe posterolateral knee instability who met the selection criteria between June 2013 and August 2017 were retrospectively analyzed.There were9 males and 3 females,with a median age of 34.5 years(range,18-57 years).The average time from injury to surgery was10.5 months(range,3-24 months).All of them were multi-ligament injuries and were treated with anatomical reconstruction of Y-shaped allogeneic Achilles tendon.The posterior and varus stress X-ray films were used to measure and calculate the difference of posterior displacement of tibia and difference of lateral joint opening distance between bilateral knees to evaluate the backward stability of LCL and knee joint;the knee flexion 30°tibial external rotation test was used to calculate the difference of tibial external rotation angle between bilateral knees to evaluate the stability of knee external rotation.The knee function was evaluated by the International Knee Documentation Committee(IKDC)2000 subjective and objective scores.Results The operation successfully completed in 12 patients,and there was no vascular and nerve injury during operation.The operation time was 2.5-3.5 hours,with an average of 2.7 hours;the intraoperative blood loss was 20-100 mL,with an average of 55 mL.All patients were followed up 13-41 months,with an average of 28.1 months.At last follow-up,the difference of posterior displacement of tibia,the difference of lateral joint opening,the difference of tibial external rotation angle between bilateral knees,and the IKDC2000 subjective score,the objective scores of tibial external rotation and knee varus significantly improved when compared with those before operation(P<0.05).The knee joint of 1 patient with anterior cruciate ligament,posterio

关 键 词：后外侧复合体 腘腓韧带 外侧副韧带 同种异体跟腱 解剖重建 

分 类 号：R687.4[医药卫生—骨科学]