Sun Zhengyu, Zhang Chenghao, Tang Xin, Chen Gang, Li Jian
Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2016 Jun 8;30(6):690-694. doi: 10.7507/1002-1892.20160140.
To evaluate the surgical procedure and short-term effectiveness of one-stage repair and reconstruction of knee dislocation with multiple ligament injuries (KDMLI).
Between September 2010 and April 2014, 9 cases (9 knees) of KDMLI were treated. There were 7 males and 2 females with an average age of 42 years (range, 27-57 years). Injury was caused by traffic accident in 3 cases, heavy-weight crushing in 3 cases, sports sprain in 2 cases, and falling from height in 1 case. The average time from injury to operation was 11 days (range, 3-19 days). The results of posterior drawer test and Lachman test were positive in all patients. The results of varus stress testing were three-degree positive in 4 cases, and the results of valgus stress testing were three-degree positive in 6 cases. The Lysholm score of knee was 27.2±6.3; the International Knee Documentation Committee (IKDC) score was 29.7±6.5; and the range of motion (ROM) was (52.6±12.8)°. All patients suffered from posterior cruciate ligament (PCL) injury and femoral avulsion injury of anterior cruciate ligament (ACL). Combined injuries included medial collateral ligament (MCL) injury in 4 cases (medial meniscus injury in 1 case), lateral collateral ligament (LCL) injury in 2 cases, and MCL and LCL injuries in 2 cases (medial meniscus and lateral meniscus injuries in 1 case). Autologous harmstring tendon was used to reconstruct PCL under arthroscopy combined with limited open in situ suture for repair of femoral avulsion injury of ACL, and repair of MCL, LCL, and other injury in one-stage operation.
All incisions healed by first intention. Joint effusion of knee occurred in 1 case and was cured after removal of fluid combined with pressure bandage. All patients were followed up 12-36 months with an average of 22 months. At last follow-up, the result of posterior drawer test was negative in all patients. The results of Lachman test were one-degree positive in 2 cases; the result of varus stress testing was one-degree positive in 1 case; the results of valgus stress testing were one-degree positive in 2?cases; and flexion dysfunction of the knee was observed in 1 case. The Lysholm score of knee was 87.3±6.6; the IKDC score was 88.9±6.8; and the ROM was (121.7±12.3)°, all showing significant differences when compared with preoperative ones (=44.246, =0.000; =37.903, =0.000; =19.894, =0.000).
For KDMLI, one-stage repair and reconstruction using autologous harmstring tendon to reconst ruct PCL under arthroscopy combined with limited open in situ suture repair of femoral avulsion injury of ACL, and repair MCL, LCL, and other injury has such advantages as minimal invasiveness, reliable fixation, less complications, and fast recovery, which can significantly improve the stability, ROM, and function of knee and obtain good short-term effectiveness.
评估一期修复重建合并多发韧带损伤的膝关节脱位（KDMLI）的手术方法及短期疗效。
2010年9月至2014年4月，治疗9例（9膝）KDMLI患者。其中男性7例，女性2例，平均年龄42岁（范围27 - 57岁）。损伤原因：交通事故3例，重物挤压3例，运动扭伤2例，高处坠落1例。受伤至手术的平均时间为11天（范围3 - 19天）。所有患者后抽屉试验和Lachman试验结果均为阳性。内翻应力试验结果4例为Ⅲ度阳性，外翻应力试验结果6例为Ⅲ度阳性。膝关节Lysholm评分为27.2±6.3；国际膝关节文献委员会（IKDC）评分为29.7±6.5；活动范围（ROM）为（52.6±12.8）°。所有患者均有后交叉韧带（PCL）损伤及前交叉韧带（ACL）股骨髁撕脱伤。合并损伤包括内侧副韧带（MCL）损伤4例（其中1例合并内侧半月板损伤），外侧副韧带（LCL）损伤2例，MCL和LCL联合损伤2例（其中1例合并内侧半月板和外侧半月板损伤）。采用自体腘绳肌腱在关节镜下重建PCL，联合有限切开原位缝合修复ACL股骨髁撕脱伤，并一期修复MCL、LCL及其他损伤。
所有切口均一期愈合。1例出现膝关节积液，经抽液加压包扎后治愈。所有患者均获随访，随访时间12 - 36个月，平均22个月。末次随访时，所有患者后抽屉试验结果均为阴性。Lachman试验结果2例为Ⅰ度阳性；内翻应力试验结果1例为Ⅰ度阳性；外翻应力试验结果2例为Ⅰ度阳性；1例出现膝关节屈曲功能障碍。膝关节Lysholm评分为87.3±6.6；IKDC评分为88.9±6.8；ROM为（121.7±12.3）°，与术前比较差异均有统计学意义（=44.246，=0.000；=37.903，=0.000；=19.894，=0.000）。
对于KDMLI，采用自体腘绳肌腱在关节镜下重建PCL，联合有限切开原位缝合修复ACL股骨髁撕脱伤，并一期修复MCL、LCL及其他损伤，具有创伤小、固定可靠、并发症少、恢复快等优点，可显著提高膝关节的稳定性、ROM及功能，获得良好的短期疗效。
