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采用单半腱肌自体移植物改良的解剖后外侧角重建技术的临床和影像学结果。

Clinical and radiological outcomes of a modified anatomic posterolateral corner reconstruction technique using a single semitendinosus autograft.

机构信息

Department of Orthopaedics, Tanta Faculty of Medicine, Tanta University, El-Gash St. Medical Campus, Tanta, El-Gharbia Governorate, Egypt.

出版信息

Arch Orthop Trauma Surg. 2023 Sep;143(9):5767-5776. doi: 10.1007/s00402-023-04862-6. Epub 2023 May 4.

Abstract

PURPOSE

We aimed to assess the clinical and radiological outcomes of a modified anatomical posterolateral corner (PLC) reconstruction technique using a single autograft.

METHODS

This prospective case series included 19 patients with a posterolateral corner injury. The posterolateral corner was reconstructed using a modified anatomical technique that utilized adjustable suspensory fixation on the tibial side. Patients were evaluated subjectively using the international knee documentation form (IKDC), Lysholm, and Tegner activity scales and objectively by measuring the tibial external rotation angle, knee hyperextension, and lateral joint line opening on stress varus radiographs before and after surgery. The patients were followed-up for a minimum of 2 years.

RESULTS

Both IKDC and Lysholm knee scores significantly improved from 49 and 53 preoperatively to 77 and 81 postoperatively, respectively. The tibial external rotation angle and knee hyperextension showed significant reduction to normal values at the final follow-up. However, the lateral joint line opening measured on the varus stress radiograph remained larger than the contralateral normal knee.

CONCLUSION

Posterolateral corner reconstruction with a hamstring autograft using a modified anatomical reconstruction technique significantly improved both the subjective patient scores and objective knee stability. However, the varus stability was not completely restored compared with the uninjured knee.

LEVEL OF EVIDENCE

Prospective case series (Level of evidence IV).

摘要

目的

我们旨在评估使用单一切口自体移植物的改良解剖后外侧角(PLC)重建技术的临床和影像学结果。

方法

本前瞻性病例系列纳入了 19 例后外侧角损伤患者。后外侧角采用改良解剖技术重建,胫骨侧采用可调式悬吊固定。通过国际膝关节文献委员会(IKDC)、Lysholm 和 Tegner 活动量表进行主观评估,通过测量术前和术后的胫骨外旋角度、膝关节过伸和外侧关节线开口的应力下内翻位片进行客观评估。患者的随访时间至少为 2 年。

结果

IKDC 和 Lysholm 膝关节评分分别从术前的 49 分和 53 分显著提高至术后的 77 分和 81 分。胫骨外旋角度和膝关节过伸在最终随访时明显恢复至正常范围。然而,在应力内翻位片上测量的外侧关节线开口仍大于对侧正常膝关节。

结论

采用改良解剖重建技术的腘绳肌自体移植物重建后外侧角显著改善了患者的主观评分和膝关节的客观稳定性。然而,与未受伤的膝关节相比,内翻稳定性并未完全恢复。

证据等级

前瞻性病例系列(证据等级 IV)。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9a36/10449660/b12314fa5587/402_2023_4862_Fig1_HTML.jpg

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