急性膝关节后内侧角损伤

[目的]探讨急性膝关节后内侧角损伤的诊断与治疗。[方法]自2000年12月～2004年1月收治急性膝关节损伤12例(12膝),病人均表现为伸膝位和屈膝30°位外翻应力试验阳性和伤膝旋转不稳定,于伤后2～12d接受了关节镜检查及内侧开放探查,12膝均有后内侧角损伤和内侧副韧带损伤,4膝伴前、后交叉韧带断裂;2膝伴前交叉韧带断裂;4膝伴后交叉韧带断裂。12膝均一期手术修复后内侧角和内侧副韧带。8周后,12例病人中8人接受二期关节镜下手术,前交叉韧带重建3例,前后交叉韧带联合重建3例,后交叉韧带重建2例。[结果]一期手术后8周评估表明12膝均恢复内后侧稳定性,伸膝位和屈膝30°位外翻应力试验均为阴性。12例病人随访10～20个月,平均12.0±3.2个月,Lysholm膝关节功能评分87.08±6.28。IKDC综合评定正常(A级)4例,接近正常(B级)7例,异常(C级)1例。[结论]急性膝关节后内侧角损伤见于较高能量损伤,多为复合损伤,表现为伸膝位和屈膝30°位外翻应力试验阳性和伤膝旋转不稳定。应一期手术修复后内侧角和内侧副韧带,二期酌情重建交叉韧带。     

股骨内髁软骨波纹征对内侧半月板纵形撕裂损伤的诊断意义

目的探讨股骨内髁软骨波纹征诊断膝内侧半月板纵形撕裂损伤的特异性。方法 2013年6月-2014年6月,对56例半月板损伤患者关节镜下探查股骨内髁软骨是否存在波纹征,明确半月板损伤类型;同时行半月板修复及韧带重建术。男35例,女21例;年龄12~38岁,平均22.2岁。致伤原因:运动伤40例,摔伤10例,交通事故伤6例。左膝22例,右膝34例。病程10~40 d,平均20.2 d。单纯内侧半月板损伤15例;合并前交叉韧带损伤38例,后交叉韧带损伤2例,髌骨脱位1例。结果关节镜下探查示患者股骨内髁软骨均出现波纹征,其中轻度23例、中度28例、重度5例;内侧半月板损伤均为纵形撕裂损伤。结论关节镜下发现股骨内髁波纹征提示可能存在内侧半月板纵形撕裂损伤。     

关节镜下重建膝关节前交叉韧带47例的治疗体会

<正>膝关节前交叉韧带断裂多因膝关节强力过伸或强力外展损伤的结果,它可合并膝内侧副韧带和内侧关节囊损伤,也可合并后交叉韧带、外侧副韧带,以及半月板的损伤,导致膝关节不稳定和功能障碍。本院从2002年至2007年在关节镜下对47例前交叉韧带断裂患者进行重建手术,取得了比较满意的结果。     

关节镜下膝前交叉韧带与后交叉韧带联合重建

[目的]探讨膝关节双交叉韧带损伤的临床特点,评估关节镜下前交叉韧带(ACL)与后交叉韧带(PCL)联合重建的技术和效果。[方法]自2001年9月~2005年2月,13例病人(13膝)经关节镜检查证实ACL和PCL均断裂,其中5膝伴后内侧角(PMC)、内侧副韧带损伤(MCL),4膝伴后外侧角损伤(PLC),2膝伴外侧半月板破裂,1膝伴内侧半月板损伤,3膝伴腘动脉损伤,2膝伴腓总神经损伤。7例病人于损伤后急性期入院,2膝于急性期行腘血管探查修复,4膝行膝后内侧角、内侧副韧带修复。13例病人于伤后4~12周在关节镜下行自体移植物单束ACL和PCL联合重建术,其中4例同期后1/2股二头肌腱重建后PLC,1例同期阔筋膜PMC、MCL重建。[结果]本组术后早期均未发生严重并发症。术后随访10~39个月,平均(21.85±9.28)个月,Lysholm膝关节功能评分为75~95分,平均(86.54±6.89)分。国际膝关节文件编制委员会(IKDC)综合评定由术前显著异常(D级)13例,改进为随访时正常(A级)3例、接近正常(B级)8例、异常(C级)2例。13例病人中,11例恢复至伤前运动水平,2例运动水平较伤前减低。[结论]膝关节双交叉韧带损伤多伴有其它重要结构损伤,需妥善处理合并损伤。关节镜下自体移植物联合单束重建ACL和PCL创伤小、手术操作精细,术后膝关节功能恢复满意。     

膝交叉韧带损伤的早期手术修复

我们从1992年～1994年收治11例新鲜的膝交叉韧带损伤患者并进行早期手术修复,疗效较好,报道如下。　　临床资料　本组11例中,男9例,女2例;年龄17～58岁;前后交叉韧带同时断裂5例,前交叉韧带断裂2例,后交叉韧带断裂4例;合并半月板损伤5例,内侧副韧带损伤4例,外侧副韧带损伤...     

带骨瓣髌韧带移植修复膝内侧副韧带陈旧性损伤

2001-2004年,收治陈旧性膝内侧副韧带损伤11例,采用带骨瓣髌韧带移植修复膝内侧副韧带,效果较好。1临床资料本组11例中,男9例,女2例;年龄18~42岁,平均为29岁。损伤原因:车祸伤3例,扭伤7例,坠落伤1例。损伤后时间为4周~1年,平均3个月。合并半月板损伤1例和前交叉韧带陈旧性断裂1     

膝内侧副韧带松解技术在内侧间室狭窄半月板损伤关节镜手术中的应用

目的探讨经皮针刺拉花松解膝内侧副韧带技术在内侧间隙狭窄内侧半月板损伤关节镜手术中用于扩大膝关节内侧间隙的有效性和安全性。方法回顾性分析自2018-05—2019-09采用关节镜手术治疗的16例合并膝内侧间隙狭窄的内侧半月板损伤,术中采用经皮针刺拉花松解内侧副韧带技术增加膝内侧间室的镜下显露范围与手术操作空间,顺利完成半月板部分切除或修复手术。结果 16例均获得随访,随访时间平均10(6~18)个月。所有患者均无医源性骨软骨损伤及血管神经损伤。4例术后出现膝关节内侧副韧带松解处疼痛、皮下瘀斑,术后2周逐渐缓解。术后3例外翻应力试验Ⅰ度阳性,术后1个月转为阴性。膝内侧副韧带松解前膝关节最大外翻位时膝内侧间隙为(7.6±1.3)mm,松解后为(12.1±1.4)mm,差异有统计学意义(P<0.05)。结论对于采用关节镜手术治疗的膝内侧间隙狭窄的内侧半月板损伤患者,经皮针刺拉花松解膝内侧副韧带技术简单可靠、安全有效,可增大关节镜手术中膝关节内侧间室手术视野和操作空间,有利于进行半月板部分切除或修复,避免了医源性骨软骨损伤。     

采用内侧半月板重建后交叉韧带

在膝关节屈伸及旋转活动中,后交叉韧带起着十分重要的作用,后交叉韧带的损伤不仅造成关节直向不稳,还可导致膝关节旋转不稳和侧方不稳,临床上必须进行适当治疗。作者曾对4例陈旧性后交叉韧带损伤患者,利用其内侧半月板对损伤的后交叉韧带进行了重建,取得了较满意的效果,未见文献报道,现介绍如下: 手术方法 采用膝内侧长弧形切口,沿股内侧肌外缘分离,暴露并切开关节囊,将关节囊连同髌骨向外侧翻转,显露关节腔,探查后交叉韧带,见后交叉韧带断裂诊断无误后,沿内侧半月板周围部剪开,游离内侧半月板前角及体部,保留后角,用钢丝“8”字穿扎固定内侧半月板前角,于股骨内髁外侧面原后交叉韧带附着点钻一骨隧道穿至股骨皮质外,将钢丝游离端穿过骨隧     

膝关节前十字韧带合并半月板损伤不同治疗方法的远期观察

本文为135例前十字韧带修补或重建术后6～16年病人的作回顾性分析。将病人分为两组进行比较。Ⅰ组:急性完全性前十字韧带断裂55例,大多数合并侧副韧带断裂,平均年龄28±10(12～59)岁。除3例外,均作前十字韧带缝合修复。19例内侧、4例外侧半月板行手术切除,1例内侧半月板撕裂修补,1例外侧半月板破裂未处理。Ⅱ组:慢性前十字韧带损伤80例,平均年龄27±9岁。其中大多数于伤后2年行外侧关节外肌腱固定术。本组再根据合并损伤分为4小组,每组20例。Ⅱ组A:半月板未受损。Ⅱ组B:已行半月板修补一年后,关节镜检查证实修复成功,同膝另一侧半月板未受损。Ⅱ组C:18例内侧和2例外侧半月板于     

Segond骨折的诊治分析

目的：探讨Segond骨折的临床特点和手术治疗的方法与时机。方法：自2008年6月至2011年12月收治16例Segond骨折,6例于伤后1周内行关节镜探查发现前交叉韧带完全断裂,半月板损伤;10例于伤后8～10周行关节镜探查,发现4例前后交叉韧带完全断裂,4例前交叉韧带完全断裂,2例前交叉韧带部分断裂,其中前交叉韧带完全断裂的8例合并半月板损伤,前交叉韧带不全断裂的1例半月板未见明显损伤,1例合并腓骨头骨折与外侧副韧带损伤。所有交叉韧带完全断裂和不全断裂的患者在关节镜探查后行交叉韧带重建术,5例半月板损伤患者行半月板缝合或成形术。术后采用Lysholm—Gillquist膝关节评分进行疗效评定。结果：伤后1周内行手术治疗的6例术后3d时膝关节肿胀明显,关节腔穿刺抽吸有淡血性液抽出,术后1周时始佩戴护具下床活动。伤后8-10周内行手术治疗的10例术后3d时膝关节无明显肿胀,关节腔穿刺抽吸无淡血性液抽出,术后3d即佩戴护具下床活动。所有患者术后获随访,时间12—50个月,平均24个月。术后Lysholm—Gillquist膝关节评分高于术前。所有病例获得满意效果。结论：Segond骨折常合并前交叉韧带损伤和半月板损伤,早期正确诊断对治疗十分重要,关节镜下行交叉韧带重建及半月板修复的最佳手术时间宜在术后8-10周内进行。     

膝前、后交叉韧带与内侧副韧带损伤的一期修复重建

目的探讨膝关节镜下重建前、后交叉韧带联合有限切开修复内侧副韧带恢复膝关节稳定和功能的疗效。方法 2003年4月-2010年10月,收治14例(14膝)前、后交叉韧带伴内侧副韧带损伤患者。男10例,女4例;年龄21～71岁,平均41岁。致伤原因:交通事故伤11例,高处坠落伤3例。患者受伤至入院时间为1～4 d,平均2 d。Lysholm评分为(17.00±8.29)分,国际膝关节文献委员会(IKDC)评分为(20.93±8.28)分。伴膝关节脱位9例,半月板损伤5例。关节镜下采用同种异体肌腱(2例)或自体腘绳肌腱(12例)重建前、后交叉韧带,有限切开修复内侧副韧带。结果术后切口均Ⅰ期愈合;3例出现下肢麻木,自行缓解。患者均获随访,随访时间为12～18个月,平均14个月。患者膝关节均于3个月内达屈曲120°,伸直0°。术后1年膝关节IKDC评分为(89.93±6.26)分,Lysholm评分为(88.93±4.82)分,与术前比较差异有统计学意义(P<0.01)。结论对于膝关节韧带多发伤,关节镜配合有限切开修复重建韧带,避免了开放关节腔,同时由于创伤小,术后关节粘连轻,关节功能恢复快。     

The triple PCL sign: bucket handle tears of both medial and lateral menisci in a chronically ACL-deficient knee

Bucket handle tears of both menisci in the setting of acute or chronic anterior cruciate ligament (ACL) tears of the same knee have rarely been reported in the literature. This article presents a case of a bucket handle tear affecting both the medial and lateral menisci in a patient with chronic ACL rupture. Both bucket handle tears were displaced and locked in the intercondylar notch. A new magnetic resonance image (MRI) sign suggested on sagittal view is called the triple PCL sign, comprising the intact posterior cruciate ligament (PCL) and the 2 displaced fragments in the intercondylar notch from the two bucket handle tears. The precise diagnosis of this condition is of obvious importance for optimal operative planning. While finding the displaced fragment from the medial meniscus is expected to cause the double PCL sign, the torn ACL may have made it easier to visualize the bucket handle tear of the lateral meniscus in the same sagittal plane as the PCL. Only 5 other reports mention bimeniscal bucket handle tears of both the medial and lateral menisci in association with an ACL tear. None have shown the suggested triple PCL sign because of lack of overlap between the 2 bucket handle tears in the coronal plane while lying in the intercondylar notch causing them not to fall in the same sagittal plane. Our patient showed some overlap between the 2 meniscal fragments while lying in the notch to create the triple PCL sign on sagittal MRI.     

关节镜下修复重建膝关节脱位合并多发韧带损伤的疗效观察

目的 探讨关节镜下重建断裂的前交叉韧带(anterior cruciate ligament,ACL)和后交叉韧带(posteriorcruciate ligament,PCL)及修复膝关节内部结构,治疗膝关节脱位合并多发韧带损伤的临床疗效.方法 2003年7月-2006年8月,收治24例膝关节脱位患者,采用关节镜下重建ACL和PCL,修复内侧副韧带(medial collateral ligament,MCL)、外侧副韧带(lateral collateralligament,LCL)和其他膝关节损伤结构.男19例,女5例;年龄20～69岁,平均42岁.均为单膝损伤,其中左膝11例,右膝13例.于伤后4h～6个月入院.ACL、PCL、MCL及LCL损伤8例,ACL、PCL及MCL损伤12例,ACL、PCL及LCL损伤4例.合并腓总神经损伤1例,内侧半月板损伤3例,外侧半月板损伤7例.评估患者术后并发症、膝关节活动范围和手术前后症状改善情况,Lysholm评分评估手术前后膝关节功能情况.结果 术后患者均获随访11～36个月,平均25个月.4例出现轻微关节僵硬,3例出现轻微关节疼痛,均未作特殊处理.11例(45.8%)运动功能恢复至伤前运动水平;13例(54.2%)显著改善,不需要辅助独立行走.24例Lachman试验、膝内外翻应力试验及前、后抽屉试验均为阴性,胫骨前后移动均<5 mm.1例腓总神经损伤者感觉运动恢复良好.Lysholm膝关节功能评分术前(41.8 ±4.3)分,术后(87.0±6.0)分:关节活动范围术前(87.5±12.5).术后(125.0 ±9.2)°术前、后比较差异均有统计学意义(P<0.05).结论 膝关节脱位后关节镜下重建ACL、PCL和修复其他膝关节结构是治疗膝关节脱位的一种有效方法.     

An unusual rotational injury: pantibial ligamentous injury

Pantibial ligamentous injury including knee dislocation and tibiotalar joint subluxation is an uncommon severe rotational injury. A 21-year-old male injured his right knee falling from a motorcycle. Physical examination revealed effusion on the right knee and ankle, and posterior translation of the tibia as well. The MRI of the right knee and ankle demonstrated the following findings: a complete disruption of cruciate ligaments, the medial collateral ligament, posteromedial corner injury together with a peripheric tear in the medial meniscus, the ruptured deltoid ligament, ankle syndesmosis space widening (>5 mm) and lateral subluxation of talus. Deltoid ligament of the right ankle was repaired and ankle syndesmosis was fixed with a cortical screw. The PCL and ACL were reconstructed arthroscopically with autogeneous bone-patellar tendon-bone graft. The midsubstance tear of MCL, posteromedial corner and medial meniscus tear were primarily repaired with nonabsorbable sutures. 3 years after the surgery, the patient was called for the final examination. MRI and X-ray findings of the knee and ankle joint demonstrated the continuity of ACL, PCL, MCL, and deltoid ligament. The patient, who is a farmer, can go back to his job and perform his daily activities. We presented a previously unreported case that involves both simultaneous occurrence of knee dislocation and tibiotalar joint subluxation. We used the term “Pantibial ligamentous injury” for this case.     

What is the terrible triad?

In 1936 Campbell asserted that "impairment of the anterior crucial and mesial ligaments is associated with injuries of the internal cartilage." O'Donoghue in 1950 called attention to "that unhappy triad (1) rupture of the medial collateral ligament, (2) damage to the medial meniscus, and (3) rupture of the anterior cruciate ligament" and recommended early surgical intervention. In 1955 he reported 33 cases with both medial collateral (MCL) and anterior cruciate ligament (ACL) tears, but there were only three lateral meniscus tears reported. Based on a recent report by Shelbourne and Nitz that questions the validity of this unhappy triad, a review of all arthroscopically confirmed acute injuries of second degree or worse to the ACL and MCL was undertaken. Of a total of 52 knees reviewed, 50 knees had third-degree ACL tears and two had second-degree ACL tears. One of the second-degree tears was associated with a second-degree MCL and one with a third-degree ACL tear. Neither had an associated meniscus tear. Forty-five third-degree ACL tears were associated with third-degree MCL tears (group 1) and five with second-degree MCL tears (group 2). Eighty percent (36 knees) of group 1 had lateral meniscus tears. Only 29% of group 1 (13 knees) had associated medial meniscus tears. None of these medial meniscus tears was isolated. Eighty percent (four knees) of group 2 had lateral meniscus tears with only one associated medial meniscus tear. Again, there were no medial meniscus tears in the absence of a lateral meniscus tear. We did not find the combination of injury originally described as the unhappy triad.     

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。     

膝关节半月板和韧带损伤磁共振成像诊断

目的探讨磁共振成像(MRI)对膝关节损伤诊断价值和意义。方法行MRI检查并经手术或关节镜证实的病例27例,采用西门子公司1.5T超导型磁共振成像系统。均做矢状及冠状面扫描,层厚4mm。对8例有前交叉韧带(ACL)损伤和22个没有ACL损伤的膝关节,分别测量后交叉韧带(PCL)角和弯曲度指数,并进行统计学分析。结果23例31个半月板损伤,术前MRI确诊18例,24个半月板,确诊率分别为62.07%和77.42%。半月板损伤的MRI表现:①半月板内可见线条样异常信号影,延伸到关节表面(Ⅲ度);②半月板变小,内侧缘变纯;③半月板失去正常三角形结构;④半月板边缘凹凸不平,呈波浪状改变;⑤半月板外缘与关节囊之间距离增宽。在9例有ACL损伤的病例中,仅有5例术前得到明确诊断,确诊率为55.56%。PCL角和弯曲度指数测量结果在ACL损伤组和非损伤组间具有显著性差异(P<0.01)。结论MRI对半月板和韧带损伤绝大多数能显示损伤的部位和程度,但诊断半月板损伤时,应注意辨别易混淆的正常结构和有些容易漏诊的MRI表现;对可疑ACL损伤者,在观察直接征象同时,应注意分析间接征像。     

Isolierte und kombinierte Kniebandverletzungen

Complex knee ligament injuries are characterized by simultaneous rupture of the anterior cruciate ligament (ACL) and/or the posterior cruciate ligament (PCL) and at least one collateral ligament. Isolated injury to the medial collateral ligament (MCL) and PCL have a high healing capacity and can be treated conservatively in many cases. Ruptures of the MCL can also be treated conservatively in complex injuries if the cruciate ligaments are reconstructed. Ruptures of the lateral structures usually need surgical reconstruction. Indications for acute surgical repair include meniscus dislocation, entrapment of collateral ligament portions in the joint, knee dislocation with severe knee instability, and displaced bony avulsions. The anatomy of the knee ligaments must be carefully respected in surgical reconstruction. Acute repair of collateral ligament injuries is possible only in the first 2 weeks after trauma. Acute arthroscopy is indicated only in combination with reconstructive surgery.     

膝关节前交叉韧带急性损伤早期关节镜下检查和手术治疗

目的 探索关节镜下早期微创修复与重建膝关节交叉韧带（ＡＬＣ）的方法。方法 对２３例ＡＣＬ急性完全断裂者施行了早期关节镜术。结果 １８例主前诊断相符;３你关节镜下明确诊断,２例发现断裂：观察到内侧副韧带断裂间接与直接损伤征象各２例。ＡＣＬ断裂病理类型：韧带体部断裂２１例,上、下止点撕脱各１例。２１例早期重建ＡＣＬ中,６例在关节镜下完成。结论 ＡＣＬ急性损伤早期施以关节镜手术,创伤小、诊断明确,可观察     

Vascular physiology and long-term healing of partial ligament tears.

Functional outcomes of anterior cruciate ligament (ACL) injury are generally poorer than those of medial collateral ligament (MCL) tears. Following ligament damage, all phases of ligament healing require an adequate blood supply. We hypothesized that the differences in healing properties of the ACL and MCL would reflect their vascular responses to joint injury. This paper examines the long-term changes in blood flow and vascular volume of rabbit knee ligaments after direct injury, and under conditions of chronic joint instability induced by section of the posterior cruciate ligament (PCL). Standardized injuries were surgically induced in adult rabbit knee ligaments: partial MCL transection, partial ACL transection, or complete PCL transection (joint instability). Sixteen weeks later the blood flow and vascular volume of the ACL and MCL were measured and compared to control and sham-operated animals. Direct ligament injury induced significant increases in standardized blood flow and vascular volume of both ACL and MCL after 16 weeks; however, the vascular volume of the ACL was not higher than the control levels in the MCL. We conclude that direct injury to both the anterior cruciate and MCLs induces long-term physiological responses. Joint laxity is a common sequel to PCL injury. Chronic joint laxity failed to induce adaptive vascular responses in the ACL, while the MCL shows significant amplification of blood supply. Although both MCL and ACL showed increased weight after PCL transection, the lack of a long-term vascular response in the ACL may be a major factor in its the diminished healing potential.