Stannard James P, Black Brandee S, Azbell Chris, Volgas David A
Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, MO 65212, USA.
J Knee Surg. 2012 Nov;25(5):429-34. doi: 10.1055/s-0032-1322605. Epub 2012 Aug 6.
Surgeons are often faced with very limited data available to make informed decisions regarding the appropriate treatment of patients with posteromedial corner (PMC) injuries of the knee. This study compared the outcomes of surgical repair versus reconstruction in knee dislocation patients who have sustained injury to the PMC of the knee. Senior author treated 113 consecutive knee dislocations with 115 PMC injuries over 7 years. A total of 71 knee dislocation patients with 73 PMC tears qualified for the study and were followed for a mean of 43 months. Patients who had a PMC repair were assigned to treatment Group A. Group B included patients who had autograft reconstruction of the PMC. Patients who had an allograft PMC were assigned to Group C. A total of 25 patients had a repair, with 5 failures (20%), whereas 48 patients had reconstruction of the PMC with 2 failures (4%). There was a significant difference between the failure rate of PMC repairs and PMC reconstructions. Reconstruction of the PMC using a technique that reestablishes the critical triangle of the medial collateral ligament, the posterior oblique ligament, and the semitendinosus yielded better stability than repair in patients with a knee dislocation that included PMC instability.
外科医生在面对膝关节后内侧角（PMC）损伤患者的适当治疗时，往往只能获得非常有限的数据来做出明智的决策。本研究比较了膝关节脱位且伴有PMC损伤的患者行手术修复与重建的效果。资深作者在7年时间里连续治疗了113例膝关节脱位患者，其中115例伴有PMC损伤。共有71例膝关节脱位患者、73处PMC撕裂符合研究条件，并接受了平均43个月的随访。接受PMC修复的患者被分配到A组。B组包括接受PMC自体移植重建的患者。接受PMC同种异体移植的患者被分配到C组。共有25例患者接受了修复，其中5例失败（20%），而48例患者接受了PMC重建，其中2例失败（4%）。PMC修复和PMC重建的失败率之间存在显著差异。对于伴有PMC不稳定的膝关节脱位患者，采用重建内侧副韧带、后斜韧带和半腱肌关键三角的技术进行PMC重建，其稳定性优于修复。
