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创伤性膝关节脱位后前后交叉韧带的同种异体移植重建

Allograft reconstruction of the anterior and posterior cruciate ligaments after traumatic knee dislocation.

作者信息

Shapiro M S, Freedman E L

机构信息

Department of Orthopaedic Surgery, University of California Los Angeles Medical Center 90024, USA.

出版信息

Am J Sports Med. 1995 Sep-Oct;23(5):580-7. doi: 10.1177/036354659502300511.

Abstract

Seven patients (average age, 26.3 years) with traumatic knee dislocations were retrospectively evaluated more than 2 years (average, 51 months) after having fresh-frozen allograft anterior and posterior cruciate ligament reconstructions. All patients were treated consecutively at an average of 9.6 days after injury. Two patients had arterial injuries and three patients had or developed common peroneal nerve palsy. Five patients had 20 additional injuries. All patients were enlisted in an early, aggressive physical therapy regimen with early protected weightbearing. Four patients required a manipulation under anesthesia for arthrofibrosis at an average of 16.8 weeks postoperatively (range, 6 to 33 weeks). At followup, only one patient had significant pain, three patients had rare or occasional giving way, and all seven were able to return to school or to the workplace. The functional grading was excellent in three patients, good in three patients, and fair in one patient. No patient had a significant flexion contracture; the average flexion arc was 118 degrees (range, 105 degrees to 135 degrees). Knee dislocation is a very traumatic injury, often resulting in a painful, dysfunctional knee. Anterior and posterior cruciate ligament reconstructions in young, active patients can minimize pain and optimize functional outcome. Arthrofibrosis is a common occurrence in these patients, and manipulation under anesthesia is frequently required.

摘要

对7例创伤性膝关节脱位患者进行回顾性评估,这些患者在接受新鲜冷冻同种异体前后交叉韧带重建术后超过2年(平均51个月)。所有患者均在受伤后平均9.6天接受连续治疗。2例患者有动脉损伤,3例患者有或发生腓总神经麻痹。5例患者还有另外20处损伤。所有患者均纳入早期积极的物理治疗方案,并早期进行保护性负重。4例患者因关节纤维化在术后平均16.8周(范围6至33周)接受了麻醉下手法治疗。随访时,只有1例患者有明显疼痛,3例患者有罕见或偶尔的打软腿,所有7例患者均能够重返学校或工作岗位。功能分级为3例优秀,3例良好,1例一般。没有患者有明显的屈曲挛缩;平均屈曲弧度为118度(范围105度至135度)。膝关节脱位是一种非常严重的创伤性损伤,常导致膝关节疼痛、功能障碍。对于年轻、活跃的患者,进行前后交叉韧带重建可将疼痛降至最低,并优化功能结局。关节纤维化在这些患者中很常见,常常需要麻醉下手法治疗。

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