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关节镜辅助下一期修复重建治疗膝关节后外侧脱位合并多发韧带损伤的临床疗效

[Clinical effect of one-stage arthroscopically assisted repair and reconstruction for posterolateral dislocation of knee joint with multiple ligament injuries].

作者信息

Wu Meng, Gao Li, Xia Ya-yi, Wang Shuan-ke

出版信息

Zhongguo Gu Shang. 2014 Aug;27(8):686-90.

PMID:25464597
Abstract

OBJECTIVE

To evaluate clinical outcomes of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstruction under arthroscopy and repair of the injured posteromedial complex structure of the knee joint in the treatment of posterolateral knee dislocation with multiple ligament injuries.

METHODS

From March 2008 to August 2012,22 patients (16 males and 6 females, ranging in age from 20 to 53 years old, with an average of 30.5 years old) with posterolateral dislocation of the knee were treated with primary reconstruction of ACL and PCL, combined with the repair of injuries in the posteromedial complex and soft-tissue. Eight patients had injuries caused by sports,5 patients road accidents and 9 patients falling down. The ACL was reconstructed using the gracilis and semitendinosus tendons. The PCL was reconstructed using LARS artificial ligaments (14 cases), or gracilis and semitendinosus tendons (8 cases). Suture repair was performed in 17 patients with posteromedial ligament injuries,and self-semitendinosus strengthening operations were performed in 5 patients. Continuouspassive montion (CPM) and active exercises were executed after operation at early stage. The IKDC and Lysholm system were used to evaluate therapeutic effects.

RESULTS

All the patients were regularly followed up, and the duration ranged from 11 to 56 months (averaged, 39 months). According to the IKDC scale,9 patients got a grade A result, 10 got a grade B result, and 3 got a grade C result. The IKDC subject score was 89.6±3.1 and the Lysholm scores was 90.7±1.8 at the latest follow-up, which were both better than those before operation.

CONCLUSION

Reconstructing the ACL and PCL and repairing injured posteromedial complex of the knee followed by an active rehabilitation is an effective method to treat posterolateral knee dislocation.

摘要

目的

评估关节镜下前交叉韧带(ACL)和后交叉韧带(PCL)重建以及膝关节后内侧复合结构损伤修复在治疗膝关节后外侧脱位合并多发韧带损伤中的临床疗效。

方法

2008年3月至2012年8月,对22例膝关节后外侧脱位患者(男16例,女6例;年龄20~53岁,平均30.5岁)进行ACL和PCL一期重建,并联合修复后内侧复合结构及软组织损伤。其中,运动损伤8例,交通事故伤5例,跌倒伤9例。ACL采用股薄肌腱和半腱肌腱重建。PCL采用LARS人工韧带重建14例,采用股薄肌腱和半腱肌腱重建8例。17例后内侧韧带损伤患者行缝合修复,5例患者行自体半腱肌加强手术。术后早期进行持续被动运动(CPM)和主动锻炼。采用IKDC和Lysholm评分系统评估治疗效果。

结果

所有患者均获定期随访,随访时间11~56个月,平均39个月。根据IKDC评分标准,A级9例,B级10例,C级3例。末次随访时IKDC主观评分为89.6±3.1,Lysholm评分为90.7±1.8,均优于术前。

结论

重建ACL和PCL并修复膝关节损伤的后内侧复合结构,随后积极康复治疗,是治疗膝关节后外侧脱位的有效方法。

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