前交叉韧带部分断裂的诊治  

Diagnosis and Management of Partial ACL Tears

作　　者：陈疾忤[1] 陈世益[1] 

机构地区：[1]复旦大学附属华山医院运动医学科,上海200040

出　　处：《中国运动医学杂志》2004年第3期236-239,共4页Chinese Journal of Sports Medicine

摘　　要：目的 :探讨前交叉韧带 (anteriorcruciateligament,ACL)部分断裂的诊断方法和治疗方式。方法 :2 0 0 0年 3月～ 2 0 0 2年 6月收治ACL部分断裂患者 2 4例 ,其中 7例以前内束断裂为主 ,17例以后外束断裂为主。所有病例均经关节镜检查确诊 ,其中行关节镜下ACL重建者 16例。结合症状、体征和MRI进行诊断 ,并比较前内束断裂和后外束断裂临床表现的差异。术后随访 9～ 13个月 ,平均 11个月。对手术前后膝关节Lysholm评分结果进行统计分析。结果 :本组病例出现关节不稳的 ,ACL前内束断裂者占 2 8 6 % ,后外束断裂者占 98 2 % ;体检前抽屉试验 (ADT)、Lachman试验和轴移试验 (PST)阳性率 ,前内束断裂者分别为 71 4 %、14 3%和 0 ;后外束断裂者分别为 17 6 %、98 2 %和 76 5 %。ACL重建术后Lysholm评分平均为 93 4 7± 2 6 2 ,较术前 (6 3 5 3± 8 11)明显提高(P <0 0 1)。结论 :ACL部分断裂根据损伤部位的不同临床表现也存在差异。后外束断裂者出现关节不稳较前内束常见 ,前内束断裂主要表现为前抽屉试验阳性 ,而后外束断裂常表现为Lachman试验和轴移试验阳性。对于伴有关节不稳的 ,手术重建ACL效果良好。Objective To study the maneuver of diagnosis and management of anterior cruciate ligament (ACL) partial tears. Methods 24 cases of ACL partial tears confirmed by arthroscopy including anteromedial band (AMB) tear in 7 cases and posterolateral bulk (PLB) tear in 17 cases were investigated, from Mar 2000 to Jun 2002. ACL reconstruction was performed in 16 cases under arthroscopy. Clinical findings including symptoms or signs, physical examinations and MRI were collected for differential diagnosis of AMB and PLB tear. The efficiency of ACL reconstruction was evaluated by Lysholm scale with average follow-up of 11 months. Results 28.5% AMB and 98.2% PLB tear cases showed knee instability. Regarding the results of anterior drawer test, Lachman test and pivot shift test, it is positive 71.4%, 14.3% and 0 in AMB tears respectively; and 17.6%, 98.2%, 76.5% in PLB tears. The Lysholm scores were significantly increased from preoperative 63.53±8.11 to postoperative 93.47±2.62(P<0.01). Conclusion ACL AMB and PLB tear had different symptoms and signs. PLB tear were more inclined to show knee instability. Positive result was easier to get in anterior drawer test when AMB tear and in Lachman test and pivot shift test when PLB tear. ACL reconstruction is effective for ACL partial disruption with knee instability.

关 键 词：前交叉韧带 韧带断裂 ACL 诊断方法 关节镜 膝关节 

分 类 号：R686.5[医药卫生—骨科学]