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[前交叉韧带断裂。诊断与治疗]

[Rupture of the anterior cruciate ligament. Diagnostics and therapy].

作者信息

Teske W, Anastisiadis A, Lichtinger T, von Schulze Pellengahr C, von Engelhardt L V, Theodoridis T

机构信息

Orthopädische Universitätsklinik, St.-Josef-Hospital, 44791, Bochum.

出版信息

Orthopade. 2010 Sep;39(9):883-898; quiz 899. doi: 10.1007/s00132-010-1670-9.

Abstract

Rupture of the anterior cruciate ligament (ACL) is the most common ligamentous knee injury. The knee is stabilized by the cruciate ligaments and the collateral ligaments. The ACL originates from the inner surface of the lateral condyle of the femur, runs in an anterior medial direction and inserts at the tibial plateau in the intercondyle area. The most common injury is an indirect knee trauma, typically a joint torsion in sports. Patients often describe a snapping noise followed by hemarthrosis. Concomitant injuries are lesions of the medial collateral ligament, the medial meniscus (unhappy triad) and chondral fractures. The age peak is between 15 and 30 years with a higher incidence in females. The cardinal symptom of the ACL rupture is the giving way phenomenon. The clinical diagnosis is provided by a positive Lachman test, a positive pivot shift test and the anterior drawer test. Fractures can be excluded by X-ray examination. Magnetic resonance imaging (MRI) allows the evaluation of the internal knee structures. ACL repair is carried out by arthroscopically assisted bone-tendon-bone or semitendinosus grafting techniques. Early rehabilitation is important for a good functional outcome.

摘要

前交叉韧带(ACL)断裂是最常见的膝关节韧带损伤。膝关节由交叉韧带和侧副韧带稳定。前交叉韧带起自股骨外侧髁内面,向前内侧走行,止于胫骨平台髁间区。最常见的损伤是间接性膝关节创伤,通常是运动中的关节扭转。患者常描述有弹响,随后出现关节积血。常合并的损伤有内侧副韧带、内侧半月板损伤(三联征)和软骨骨折。发病高峰年龄在15至30岁之间,女性发病率较高。前交叉韧带断裂的主要症状是打软腿现象。临床诊断依靠Lachman试验阳性、轴移试验阳性和前抽屉试验阳性。X线检查可排除骨折。磁共振成像(MRI)可用于评估膝关节内部结构。前交叉韧带修复通过关节镜辅助下的骨-肌腱-骨或半腱肌移植技术进行。早期康复对于获得良好的功能结局很重要。

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