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膝关节脱位后前后交叉韧带重建。使用新鲜冷冻未辐照同种异体移植物的结果。

Reconstruction of the anterior and posterior cruciate ligaments after knee dislocation. Results using fresh-frozen nonirradiated allografts.

作者信息

Wascher D C, Becker J R, Dexter J G, Blevins F T

机构信息

Department of Orthopaedics, University of New Mexico, Albuquerque 87131-5296, USA.

出版信息

Am J Sports Med. 1999 Mar-Apr;27(2):189-96. doi: 10.1177/03635465990270021301.

Abstract

We reviewed the results in 13 patients who underwent simultaneous allograft reconstruction of both the anterior and posterior cruciate ligaments after a knee dislocation (nine acute and four chronic injuries). Seven patients sustained related medial collateral ligament injuries and six patients had posterolateral complex injuries. Ligament reconstructions were performed using fresh-frozen Achilles or patellar tendon allografts. At follow-up evaluation (mean of 38 months), only one patient described the reconstructed knee as normal. Six patients had returned to unrestricted sports activities and four had returned to modified sports. The average extension loss was 3 degrees (range, 0 degree to 10 degrees) and average flexion loss was 5 degrees (range, 0 degree to 15 degrees). The KT-1000 arthrometer measurements at 133 N anterior-posterior tibial load showed a mean side-to-side difference of 4.5 mm (range, 0 to 10) at 20 degrees and 5.0 mm (range, 0 to 9) at 70 degrees. The mean Lysholm score was 88 (range, 42 to 100). International Knee Documentation Committee ratings were six nearly normal, five abnormal, and one grossly abnormal. Two patients required manipulations for knee stiffness. This study demonstrates that reconstruction of both cruciate ligaments can restore stability sufficient to allow sports activity in most patients with knee dislocations, but "normal" results are difficult to achieve.

摘要

我们回顾了13例膝关节脱位后同时进行前交叉韧带和后交叉韧带同种异体移植重建患者的结果(9例急性损伤和4例慢性损伤)。7例患者伴有相关的内侧副韧带损伤,6例患者有后外侧复合体损伤。韧带重建采用新鲜冷冻的跟腱或髌腱同种异体移植物。在随访评估时(平均38个月),只有1例患者称重建后的膝关节功能正常。6例患者已恢复无限制的体育活动,4例患者已恢复调整后的体育活动。平均伸直受限3°(范围0°至10°),平均屈曲受限5°(范围0°至15°)。在133N的前后胫骨负荷下,KT-1000关节测量仪测量显示,在20°时平均两侧差值为4.5mm(范围0至10),在70°时为5.0mm(范围0至9)。Lysholm评分平均为88分(范围42至100)。国际膝关节文献委员会评级为6例接近正常,5例异常,1例严重异常。2例患者因膝关节僵硬需要手法治疗。本研究表明,重建两条交叉韧带可恢复足够的稳定性,使大多数膝关节脱位患者能够进行体育活动,但难以获得“正常”结果。

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