膝关节后十字韧带重建术后后方松弛的原因与应对  

Causes analysis and coping strategies of posterior laxity after posterior cruciate ligament reconstruction

作　　者：蔡伟创 徐一宏 徐卫东 Cai Weichuang;Xu Yihong;Xu Weidong(Department of Orthopaedics,Changhai Hospital,The Navy Medical University,Shanghai 200433,China)

机构地区：[1]海军军医大学附属长海医院关节骨病外科,上海200433

出　　处：《中华骨科杂志》2023年第8期534-542,共9页Chinese Journal of Orthopaedics

基　　金：海军军医大学第一附属医院"234学科攀峰计划"项目(2020YXK002);2020年上海市体育科技"备战攻关"项目(20J017)。

摘　　要：后十字韧带(posterior cruciate ligament, PCL)重建术后难以维持初始的膝关节后方稳定性, 术后残留膝关节后方松弛一直是PCL重建术后的难题。不仅导致膝关节出现异常的运动学表现, 而且持续的后方松弛, 尤其是严重的后方松弛, 更可能继发患侧膝关节半月板损伤、软骨退变, 最终导致膝关节骨关节炎发生。PCL重建术后残留膝关节后方松弛的主要原因包括:膝关节后外侧角损伤处理不当、股骨骨隧道定位不佳、胫骨平台后倾角过小及术后康复不合理等。采用人工韧带重建PCL、胫骨侧悬吊固定或联合界面螺钉双重固定、增粗移植物直径、全内重建联合缝线增强技术、术后缓慢渐进的康复锻炼等理念和技术, 可以消除或减轻PCL重建术后残留后方松弛, 提高PCL术后的临床疗效。对胫骨后倾角过小的患者建议一期行PCL双束重建+胫骨截骨, 增大胫骨后倾角, 降低术后残留膝关节后方松弛的风险, 提高术后膝关节的后方稳定性。It is difficult to maintain the initial posterior stability of the knee after posterior cruciate ligament reconstruction.Residual posterior knee laxity after operation is a problem of PCL reconstruction.It not only results in abnormal kinematics of the knee,but also leads to secondary meniscus injury and cartilage degeneration of the affected knee,and eventually leads to knee osteoarthritis,which may especially happen with persistent and severe posterior laxity.The main reasons of residual posterior knee laxity after PCL reconstruction are:improper treatment of the posterolateral corner injury,poor positioning of the femoral tunnel,small tibial slope,and unreasonable postoperative rehabilitation.There are some concepts and technologies,such as using artificial ligaments,tibial tunnel fixation with suspensory device or suspensory device combined with interference screws,enlargement of graft diameter,all-inside reconstruction combined suture augmentation,slow and gradual postoperative rehabilitation,which can eliminate or reduce the postoperative residual laxity,in order to improve clinical outcomes after PCL reconstruction.For the patients with flat tibial slopes,double-bundle PCL reconstruction and concurrent slope-increasing tibial osteotomy is suggested.It can reduce the risk of posterior laxity and improve the stability of the knee after operation.

关 键 词：后交叉韧带重建 手术后并发症 膝关节 关节不稳定性 影响因素分析 

分 类 号：R687.4[医药卫生—骨科学]