膝关节多发韧带损伤的分型及规范化治疗策略  

Specific classification and standardized treatment strategies of multiple ligament injured knee

作　　者：杨松运[1] 陈刚[2] 何兴川 李刚池[1] 朱朝均 YANG Song-yun;CHEN Gang;HE Xing-chuan;LI Gang-chi;ZHU Chao-jun(Department of Orthopedics,Affiliated Santai Hospital of Chuanbei Medical College,Mianyang,Sichuan 621100,China;不详)

机构地区：[1]川北医学院附属三台人民医院(三台县人民医院)骨科,四川绵阳621100 [2]四川大学华西医院骨科,四川成都610041 [3]遵义医科大学附属医院骨科,贵州遵义563000

出　　处：《中国骨与关节损伤杂志》2022年第10期1024-1027,共4页Chinese Journal of Bone and Joint Injury

基　　金：四川省医学会骨科专项科研课题(2020SAT40)。

摘　　要：目的归纳总结膝关节多发韧带损伤的不同类型,制定出适合临床医师便于快速理解掌握的分型方法,根据分型结果制定出相应的规范化治疗策略,以利于临床医师及时、准确诊断与治疗。方法第一个阶段纳入自2015-01—2017-01手术治疗的50例膝关节多发韧带损伤,结合目前国内外的治疗方案及术后膝关节功能评分,先提出初步分型及规范化治疗策略。第二个阶段纳入自2017-02—2020-01手术治疗的60例膝关节多发韧带损伤,根据前期总结的初步分型及治疗策略进行诊断及治疗,术后根据患者膝关节功能评分、膝关节活动度验证分型诊断及规范化治疗效果。第三个阶段完善膝关节多发韧带损伤分型方法以及规范化治疗策略。结果110例均获得随访,随访时间平均16(12~24)个月。末次随访时膝关节活动度为110°~140°,平均122.8°;膝关节Lysholm评分为85~100分,平均86.3分;膝关节IKDC评分为86~100分,平均88.9分。末次随访时膝关节活动度、Lysholm评分、IKDC评分较术前明显改善。结论膝关节多发韧带损伤分型中将多发韧带损伤常合并的膝关节周围骨折、神经损伤、血管损伤、血栓形成纳入分析,更具临床指导意义,有利于一线临床医师及早作出正确的诊断和治疗。膝关节多发韧带损伤规范化治疗策略中贯穿微创理念,加强治疗过程中对韧带及周围组织血供的保护有利于减少并发症发生。Objective To summarize the different types of the multiple ligament injured knee,develop a classification method suitable for clinicians to quickly understand and master,and the corresponding standardized treatment strategy according to the classification results,which is conducive to timely and accurate diagnosis and treatment for clinicians.Methods In the first stage,50 cases of multiple knee ligament injuries surgically treated from January 2015 to January 2017 were included.Prelimi⁃nary classification and standardized treatment strategies were proposed based on the current domestic and foreign treatment plans and postoperative knee function scores.In the second stage,60 cases of multiple knee ligament injuries surgically treated from February 2017 to January 2020 were included.The diagnosis and treatment were performed according to the preliminary classification and treatment strategy summarized in the previous stage,and the classification diagnosis and standardized treat⁃ment effect were verified according to the knee function score and knee range of motion.The third stage was to improve the clas⁃sification method and standardized treatment strategy of multiple ligament injury knee.Results All 110 patients were followed up for an average of 16(12-24)months.At last follow-up,the range of motion of the knee was 110°-140°,with an average of 122.8°.The knee Lysholm score ranged from 85 to 100,with an average of 86.3.The IKDC score of knee joint ranged from 86 to 100(mean,88.9).At the last follow-up,knee range of motion,Lysholm score and IKDC score were significantly improved com⁃pared with those before operation.Conclusion The classification of multiple ligament injured knee includes the analysis of periknee fracture,nerve injury,vascular injury and thrombosis often associated with multiple ligament injuries,which has more clinical guiding significance and is conducive to the early diagnosis and treatment of front-line clinicians.The concept of mini⁃mally invasive surgery runs through the standardiz

关 键 词：膝关节多发韧带损伤 临床分型 规范化治疗策略 韧带修复 

分 类 号：R686.5[医药卫生—骨科学]