分期修复重建膝关节多发韧带损伤的临床疗效

目的 :探讨关节镜下分期治疗膝关节多发韧带损伤的临床疗效。方法 :2006年3月至2012年6月,关节镜下分期治疗膝关节多发韧带损伤14例(14膝)。男8例,女6例;年龄20~49岁,平均(31.8±8.1)岁。患者均行X线、MR检查,提示10例前交叉韧带、后交叉韧带及内侧副韧带损伤,4例前交叉韧带、后交叉韧带及后外侧角损伤。合并内侧半月板损伤4例,外侧半月板损伤2例。Ⅰ期手术治疗内侧副韧带损伤、后交叉韧带及半月板,术后固定3周后开始主被动功能锻炼,3~6个月后膝关节活动范围正常且存在明显松弛时Ⅱ期重建前交叉韧带和(或)后交叉韧带。结果:术后切口均Ⅰ期愈合,无感染等手术相关并发症发生。患者均获随访,时间24~80个月,平均48.9个月。末次随访时膝关节Lysholm评分达87.1±2.8,优于术前19.6±0.9(t=12.3,P0.01)。国际膝关节评分委员会(International Knee Documentation Committee,IKDC)评级:9例接近正常,5例异常。结论 :关节镜下分期治疗膝关节多发韧带损伤能有效恢复膝关节稳定性和功能。

Clinical effect of staged repair and reconstruction of multiple ligament injuries in knee joints

Objective: To evaluate clinical outcomes of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstruction under arthroscopy combined with limited open repair of medial collateral ligament (MCL) for the treatment of multiple ligament injuries of knee joints. Methods: From March 2006 and June 2012,the data of 14 patients (14 knees) with multiple injuries of ACL,PCL,and MCL were collected. There were 8 males and 6 females with an average age of(31.8±8.1)years old (ranged,20 to 49 years old). All the patients were performed with X-ray and MRI examination,and the results showed that 10 patients had combined with injuries of anterior cruciate ligament (ACL),posterior cruciate ligament(PCL) and medial collateral ligament (MCL);4 patients had ALC,PCL and posterolateral corner(PLC) injuries. Four patients had medial meniscus injuries and 2 patients had lateral meniscus injuries. The MCL,PLC and meniscus injuries were treated with operation on the first stage,and functional exercises were performed 3 weeks after fixation. The reconstruction operation of ACL and(or) PCL was performed at the second stage under arthroscopy 3 to 6 months later when the movement range of knee joint recovered to the normal level with obvious relaxation. Results: All incisions healed by primary intention. All the patients were followed up with a mean duration of 48.9 months (ranged,24 to 80 months). The Lysholm score was improved from preoperative 19.6±0.9 to the latest follow-up 87.1±2.8(t=12.3,P<0.01). The International Knee Documentation Committee(IKDC) rating:9 cases nearly recovered to normal,5 cases were abnormal. Conclusion: For multiple ligament injuries in the knee,staged repair and reconstruction can effectively restore knee joint stability and function.