Mao Yunhe, Tang Jiexi, Li Jian, Tang Xin, Li Qi
Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2020 Feb 15;34(2):190-195. doi: 10.7507/1002-1892.201907075.
To investigate the method and effectiveness of transosseous suture technique in repairing anterior cruciate ligament (ACL) avulsion injury for the multiple ligament injuries with knee dislocation (MLIKD).
The clinical data of 27 patients (27 knees) with MLIKD between September 2010 and April 2016 were analyzed retrospectively. There were 21 males and 6 females, with an average age of 42 years (range, 24-60 years). The injury was caused by traffic accident in 9 cases, heavy-weight crushing in 9 cases, sports sprain in 6 cases, falling from height in 3 cases. The interval from injury to operation was 1-19 days (mean,10.8 days). There were 20 cases of femoral avulsion injury of ACL, 7 cases of tibial avulsion injury of ACL, and there were 17 cases of posterior cruciate ligament (PCL) injuries. According to the Schenck classification, there were 15 cases of KD-Ⅲ-M type, 8 cases of KD-Ⅲ-L type, and 4 cases of KD-Ⅳ type. All patients were positive in the posterior drawer test and Lachman test; 8 cases were degree Ⅲ positive in varus stress test, and 15 cases were degree Ⅲ positive in valgus stress test. The Lysholm score of knee was 27.6±6.5, the International Knee Documentation Committee (IKDC) score was 25.5±6.2, and the range of motion (ROM) of knee was (45.1±10.2)°. The injured PCL was reconstructed with a single bundle of autologous hamstring tendon. ACL was repaired with double bundle traction by transosseous suture technique. Medial cruciate ligament, lateral cruciate ligament, joint capsule, and other damaged structures were repaired at the same time.
All incisions healed by first intention. There were 3 cases with joint effusion and 3 cases with incomplete flexion. All patients were followed up 12-36 months (mean, 22 months). The X-ray films showed good stability in all directions. At last follow-up, the anterior and posterior drawer tests were all negative; Lachman test was degreeⅠpositive in 4 cases, valgus stress test was degreeⅠpositive in 3 cases, varus stress test was degreeⅠpositive in 1 case; and all tests were negative in the rest patients. At 1 year after operation, the ROM of knee was (119.3 ±12.6)°, Lysholm score was 87.2±6.3, and IKDC score was 87.9±6.3, showing significant differences when compared with the preoperative scores ( <0.05).
Transosseous suture technique can be used to repair the ACL avulsion injury for MLIKD, which can significantly improve the stability, mobility and function of the knee joint, and obtain satisfied short-term effectiveness.
探讨经骨缝合法修复膝关节脱位多发韧带损伤（MLIKD）中前交叉韧带（ACL）撕脱伤的方法及疗效。
回顾性分析2010年9月至2016年4月收治的27例（27膝）MLIKD患者的临床资料。其中男21例，女6例，平均年龄42岁（24～60岁）。致伤原因：交通事故9例，重物挤压9例，运动扭伤6例，高处坠落3例。受伤至手术时间为1～19天（平均10.8天）。ACL股骨侧撕脱伤20例，胫骨侧撕脱伤7例，后交叉韧带（PCL）损伤17例。按Schenck分型：KD-Ⅲ-M型15例，KD-Ⅲ-L型8例，KD-Ⅳ型4例。所有患者后抽屉试验及Lachman试验均为阳性；内翻应力试验Ⅲ度阳性8例，外翻应力试验Ⅲ度阳性15例。膝关节Lysholm评分为27.6±6.5分，国际膝关节文献委员会（IKDC）评分为25.5±6.2分，膝关节活动度（ROM）为（45.1±10.2）°。采用单束自体腘绳肌腱重建损伤的PCL，经骨缝合法双束牵引修复ACL。同时修复内侧副韧带、外侧副韧带、关节囊等损伤结构。
所有切口均Ⅰ期愈合。3例出现关节积液，3例膝关节屈曲不全。所有患者随访12～36个月（平均22个月）。X线片显示各方向稳定性良好。末次随访时，前后抽屉试验均为阴性；Lachman试验Ⅰ度阳性4例，外翻应力试验Ⅰ度阳性3例，内翻应力试验Ⅰ度阳性1例；其余患者各项检查均为阴性。术后1年，膝关节ROM为（119.3±12.6）°，Lysholm评分为87.2±6.3分，IKDC评分为87.9±6.3分，与术前评分比较差异有统计学意义（P<0.05）。
经骨缝合法可用于修复MLIKD中的ACL撕脱伤，能显著提高膝关节的稳定性、活动度及功能，获得满意的短期疗效。
