前交叉韧带或后交叉韧带合并后外侧角损伤的管理：一项系统评价
Management of combined anterior or posterior cruciate ligament and posterolateral corner injuries: a systematic review.
作者信息
Rochecongar G, Plaweski S, Azar M, Demey G, Arndt J, Louis M-L, Limozin R, Djian P, Sonnery-Cottet B, Bousquet V, Bajard X, Wajsfisz A, Boisrenoult P
机构信息
Service d'Orthopédie Traumatologie, Centre Hospitalo-Universitaire de Caen, avenue de la Côte de Nacre, 14033 Caen Cedex 9, France.
Service d'Orthopédie Traumatologie, Centre Hospitalier Universitaire de Grenoble, Hôpital Sud, 38434 Echirolles Cedex, France.
出版信息
Orthop Traumatol Surg Res. 2014 Dec;100(8 Suppl):S371-8. doi: 10.1016/j.otsr.2014.09.010. Epub 2014 Oct 23.
BACKGROUND
Combined injuries to the posterolateral corner and cruciate ligaments are uncommon. The heterogeneity of injury patterns in many studies complicates the assessment of outcomes.
OBJECTIVE
To assess the prognosis and functional outcomes after surgery for combined injuries to the posterolateral corner and to the anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL).
MATERIAL AND METHODS
We systematically reviewed the literature for articles reporting outcomes 1 year or more after surgery for combined injuries to the posterolateral corner and ACL (n=4) or PCL (n=9). Patients with bicruciate injuries were not studied.
RESULTS
Overall, 65% of patients were IKDC A or B after surgery. The mean Lysholm score improved from 67 to 90. Mean time to surgery was 4.43 months in the group with ACL tears and 18.4 months in the group with PCL tears, and mean follow-up was 34.4 and 40.7 months in these two groups, respectively. In the groups with ACL and PCL tears, the proportions of patients classified as IKDC A or B at last follow-up were 81.6% and 81.0%, respectively, whereas 88% and 99% of patients, respectively, were IKDC grade C or D before surgery. The mean Lysholm score improved from 77 to 92 in the group with ACL tears and from 65 to 89 in the group with PCL tears. Improvements in laxity ranged from 28% to 79% in the group with PCL tears.
DISCUSSION
Most of the articles selected for our review provided level III or IV evidence. Functional outcomes were satisfactory but less good than those reported after surgical reconstruction of isolated cruciate ligament tears. Full reconstruction seems the best strategy in patients with combined ACL/posterolateral corner injuries. Outcomes were also good but more variable in the group with PCL/posterolateral corner injuries. The time to surgery, which reflected the time to diagnosis, was shorter in patients with ACL than with PCL tears in addition to the posterolateral corner injury.
LEVEL OF EVIDENCE
Level III (systematic literature review).
背景
后外侧角与交叉韧带联合损伤并不常见。许多研究中损伤模式的异质性使结果评估变得复杂。
目的
评估后外侧角与前交叉韧带（ACL）或后交叉韧带（PCL）联合损伤手术后的预后及功能结果。
材料与方法
我们系统检索了文献，查找报告后外侧角与ACL联合损伤（n = 4）或与PCL联合损伤（n = 9）手术后1年或更长时间结果的文章。未研究双交叉韧带损伤患者。
结果
总体而言，65%的患者术后IKDC评分为A或B级。Lysholm评分均值从67提高到90。ACL撕裂组的平均手术时间为4.43个月，PCL撕裂组为18.4个月，这两组的平均随访时间分别为34.4个月和40.7个月。在ACL和PCL撕裂组中，末次随访时分类为IKDC A或B级的患者比例分别为81.6%和81.0%，而术前分别有88%和99%的患者为IKDC C级或D级。ACL撕裂组的Lysholm评分均值从77提高到92，PCL撕裂组从65提高到89。PCL撕裂组的松弛度改善范围为28%至79%。
讨论
我们综述中所选的大多数文章提供了III级或IV级证据。功能结果令人满意，但不如单纯交叉韧带撕裂手术重建后报告的结果好。对于ACL/后外侧角联合损伤患者，完全重建似乎是最佳策略。PCL/后外侧角损伤组的结果也较好，但变异性更大。除后外侧角损伤外，ACL撕裂患者的手术时间（反映诊断时间）比PCL撕裂患者短。
证据水平
III级（系统文献综述）。
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