膝关节多韧带损伤后关节镜下前后交叉韧带重建2—10年随访结果

该文对35例膝关节多韧带损伤后关节镜下前交叉韧带(ACL)、后交叉韧带(PCL)重建后进行了2～10年的随访。其中19例为ACL、PCL和后外侧不稳定,9例为ACL、PCL和内侧副韧带(MCL)不稳定,6例为ACL、PCL、MCL和后外侧不稳定,1例为ACL、PCL不稳定。所有ACL、PCL术前都为Ⅲ度松弛,术前术后都采用Lysholm、Tegner和HSS膝关节韧带等级评定、KT-1000关节活动度测量法、应力X线成像和体检进行比较。     

关节镜下膝关节前交叉韧带损伤重建疗效观察

目的探讨膝关节镜下采用联合半腱肌与股薄肌肌腱重建修复前交叉韧带损伤的临床疗效。方法收集晋城煤业集团总医院骨科自2011年1月至2012年6月收治的前交叉韧带损伤患者共38例,采用膝关节镜下半腱肌与股薄肌肌腱重建前交叉韧带,术后随访复查内容：询问患者术后活动有无膝关节不稳症状,检查前抽屉试验是否阴性。临床疗效评价采用Lysholm评分。结果 38例患者均获随访,随访时间4～27个月,平均17个月。患膝关节功能用Lysholm膝关节评分法评定,术前平均分为（24.50±11.25）分,术后平均分为（87.25±16.17）分,手术前、后比较,差异有统计学意义（P〈0.05）。结论应用膝关节镜下采用联合半腱肌与股薄肌肌腱重建修复前交叉韧带损伤,术后功能评分较术前有很大改善,显示了很好的临床效果和安全性。     

膝关节多韧带损伤的手术治疗体会

目的 :介绍膝关节多韧带损伤的手术治疗方法和结果 ,总结治疗的经验与教训。方法 :随访自2008年至2013年经治的26例膝关节多韧带损伤患者,其中男17例,女9例;年龄29~55岁,平均40.7岁。所有患者在关节镜下采用自体或异体肌腱重建交叉韧带,并同时修补内侧副韧带、外侧副韧带及处理内外侧复合体损伤。9例分期手术,其余均采取Ⅰ期手术处理所有损伤。用Lysholm膝关节评分评价手术前后膝关节功能。结果:26例均获随访,时间为0.8~3.2年,平均1.6年,手术平均等待时间为1.2个月。术前膝关节Lysholm评分42.5±4.5(33~48分),终末随访时78.1±3.9(57~95分),随访时评分提高。术后关节活动度均超过90°,内外翻试验正常或接近正常,所有患者在屈70°时Lachman试验阴性。结论 :膝关节韧带多发损伤应首选关节镜下Ⅰ期重建;如无法Ⅰ期同时重建前后交叉韧带,则Ⅰ期先重建后交叉韧带,Ⅱ期重建前交叉韧带;后交叉韧带因多种原因易漏诊,避免因术前准备不充分而分期手术。     

关节镜下重建修复膝关节多韧带损伤

目的探讨关节镜下重建前交叉韧带(ACL)及后交叉韧带(PCL)、修复其他膝关节结构的手术效果。方法采用关节镜下重建ACL及PCL、修复其他膝关节结构治疗膝关节多韧带损伤15例。结果本组获随访12～36个月,关节活动范围术前(76.6±8.5)°,术后(119.0±11.6)°;Lysholm膝关节功能评分术前(36.3±4.6)分,术后(83.8±5.7)分,术前与术后比较差异均有统计学意义(P<0.05)。结论在关节镜下重建ACL及PCL、修复其他膝关节结构治疗膝关节多韧带损伤是一种有效的方法。     

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     

关节镜下人工韧带移植重建膝前后交叉韧带

目的回顾性研究关节镜下应用人工韧带重建膝交叉韧带的疗效。方法应用LARS人工韧带对16例交叉韧带损伤行关节镜下重建,术后予以早期康复锻练,对临床疗效进行回顾性分析。结果手术时间55～96min,平均65min。16例均随访3～30个月,平均16个月。术后无滑膜炎、韧带断裂、活动受限等并发症。按照IKDC评分标准及Lysholm膝关节功能评分进行评估,术后膝关节功能均得到良好恢复。结论LARS人工韧带的应用能避免取材部位的并发症,操作简便,可早期康复锻炼,极好的恢复关节屈伸度,获得满意疗效。     

关节镜下膝关节后交叉韧带重的临床体会

目的：总结17例关节镜下后交叉韧带重的体会。方法：关节镜下移植中1／3骨－髋韧带－骨或半腱＋股薄肌腱组织建重膝关节后交叉韧带,用于治疗后交叉韧带损伤后关节不稳定。结果：所有患平均随访时间为13．1个月。Larson评分由术前61例提高到93分。Lysholm评分由术前55分提高到91分。所有患膝术前后抽屉试验及Lachman试验均阳性,术后仅2例抽屉试验弱阳性,1例Lachman弱阳性,所有患主观评价膝关节功能明显增进,对治疗效果满意。结论：在关节镜直视下,能准确确定位后交叉韧带解剖止点,钻制骨遂道,植入移植组织,该技术具有不切开关节囊,损伤小、关节粘连率低的优点。     

关节镜下手术治疗膝关节多韧带损伤

目的观察关节镜下手术治疗膝关节多韧带损伤的临床效果。方法选取福建医科大学附属宁德市医院2010年1月至2014年1月收治的48例膝关节多韧带损伤患者,按照配对分组法分为观察组和对照组,每组24例,观察组于关节镜下行前后交叉韧带重建及内、外侧副韧带修复,对照组行开放手术。比较两组手术疗效及术后并发症情况。结果所有患者获随访16~24个月,平均随访时间20.7个月。观察组术中出血量、手术时间及术后引流量分别为(199±33)m L、(114±26)min、(46±12)m L,均显著低于对照组(246±39)m L、(145±33)min、(68±14)m L,两组比较,差异有统计学意义(P0.05)。观察组和对照组患者末次随访时关节活动度、Lysholm评分及国际膝关节文献委员会(IKDC)评分分别为(119±6)°、(90±6)分、(80±5)分和(111±6)°、(82±5)分、(72±5)分,均明显优于术前的(62±6)°、(32±5)分、(24±5)分和(65±6)°、(34±5)分、(25±5)分(P0.05);两组患者术前上述指标比较,差异无统计学意义(P0.05),但观察组末次随访时关节活动度、Lysholm评分及IKDC评分均高于对照组(P0.05)。结论关节镜下手术治疗膝关节多韧带损伤术中出血量和术后引流量小、手术时间短、膝关节活动度及功能恢复良好,疗效理想。     

关节镜下膝关节交叉韧带断裂重建术

[目的]探讨膝关节镜下采用自体腘绳肌肌腱重建前/后交叉韧带的方法和效果.[方法]回顾性分析38例关节镜下应用自体腘绳肌肌腱单束四股移植重建前/后交叉韧带的情况,采用Lysholm 关节评分评价疗效.[结果]平均随访26.5 个月,Lysholm 关节评分由术前52分提高到术后91分,优良率89.5%.[结论]关节镜下自体腘绳肌肌腱单束四股重建前/后交叉韧带创伤小,疗效优良,稳定性好,并发症少.早期系统训练可改善预后.     

关节镜下人工韧带治疗膝后交叉韧带损伤

通过对１１例膝后交叉韧带（ＰＣＬ）,对断裂患者在关节镜下行Ｇｏｒｅ－Ｔｅｘ人工韧带重建ＰＣＬ,对近期随访结果进行分析,随访９￣２１个月,平均１７个月。术后所有患膝不稳定症状消失。Ｌａｃｈｍａｎ试验阴性,后抽屉试验阴性骨折关节功能良好。根据Ｌｙｓｈｏｌｍ膝关节评分法,平均积分由术前的５４分提高到术后的８９分。认为关节镜下代 韧带治疗后交叉韧带损伤手术反应小,恢复快,近期疗效肯定,过 铲尚待日后更深入     

Surgical management of multiple knee ligament injuries

Objectives

To summarize our experience and mid-term results of reconstruction with Iliotibial tract grafts for multiple ligament injuries.

Methods

Between July 1997 and December 2003, multiple ligament injuries of 15 patients were reconstructed with Iliotibial tract grafts in arthroscopy. There were 5 women and 10 men. The mean age at the time of the surgery was 30.5 years (range 25–43 years). There were 7 cases who were injured with combined ACL rupture and the PCL, and 8 cases were with disruption of both the ACL and the PCL, combined with damage of the medial collateral ligament.

Results

Fifteen patients were followed up for a mean of 7.5 years (range 6–12 years). The overall mean postoperative Lysholm score was 84.3 ± 5.7. At final IKDC qualification, 60.0 % of the knees were normal or nearly normal. The overall average Tegner activity score decreased significantly at the re-examination compared to the activity score before accident (3.6 ± 0.5 vs. 5.1 ± 0.6).

Conclusions

Reconstruction with Iliotibial tract grafts in arthroscopy was a reliable treatment for multiple ligament injuries.     

Arthroscopy in acute knee injuries

The diagnostic value of arthroscopy was evaluated in 148 patients with acute hemarthrosis and/or instability of the knee. The treatment planned after clinical examination was compared with the treatment given after arthroscopy. Seventy-nine per cent of the patients had ligamentous injuries; 59 per cent of tears were combined with other injuries, and 71 per cent were complete ruptures. Stability testing under anesthesia was most inaccurate for the anterior cruciate ligament, with 13 per cent false positive and 30 per cent false negative results. The planned treatment was altered as a consequence of arthroscopy in 31 per cent of cases. Without arthroscopy, the preoperative diagnoses would have been seriously wrong in 15 per cent of the patients. Twenty per cent of total anterior cruciate ligament ruptures would have been overlooked.     

Arthroscopy in acute knee injuries

The diagnostic value of arthroscopy was evaluated in 148 patients with acute hemarthrosis and/or instability of the knee. The treatment planned after clinical examination was compared with the treatment given after arthroscopy. Seventy-nine per cent of the patients had ligamentous injuries; 59 per cent of tears were combined with other injuries, and 71 per cent were complete ruptures. Stability testing under anesthesia was most inaccurate for the anterior cruciate ligament, with 13 per cent false positive and 30 per cent false negative results. The planned treatment was altered as a consequence of arthroscopy in 31 per cent of cases. Without arthroscopy, the preoperative diagnoses would have been seriously wrong in 15 per cent of the patients. Twenty per cent of total anterior cruciate ligament ruptures would have been overlooked.     

采用自体腘绳肌腱重建膝关节多发韧带损伤

目的 探讨采用自体腘绳肌腱"人"字形加强修复膝关节内侧侧副韧带浅层(sMCL)和后斜韧带(POL)的新技术,分析其对膝关节内侧稳定的作用.方法 2002年8月至2004年2月,采用自体腘绳肌腱"人"字形加强修复损伤的sMCL和POL治疗19例患者,患者均合并交叉韧带损伤且需手术重建,故有时需取健侧腘绳肌腱作为韧带重建结构.结果 19例患者得到49～67个月(平均57个月)随访.根据国际膝关节文献委员会评分系统(IKDC),所有患者膝关节在O和30°位应力外翻试验时内侧稳定性完全恢复正常.术前膝关节Lysholm评分为(58.5±4.2)分(37～70分),终末随访时为(92.2±3.6)分(84～96分),差异有统计学意义(P<0.05).其中6例患者术后3个月因膝关节活动受限而接受手法松解.除2例患者主诉健侧膝关节内侧麻木外,所有健侧患肢在取腘绳肌腱后无功能受限.结论 采用自体腘绳肌腱"人"字形增强修复损伤的sMCL和POL能有效恢复膝关节内侧稳定.     

单侧膝关节多发韧带损伤手术治疗后患者满意度调查

目的调查单侧膝关节多发韧带损伤术后满意度情况及影响因素。方法收集本院自2010-01—2015-02单侧膝关节多发韧带损伤行手术治疗的113例患者,术后1年给113例患者邮寄一份由笔者设计的单侧膝关节多发韧带损伤的满意度量表,其中包含对手术疗效的总体满意度、对具体功能和症状缓解程度的13个单项满意度以及可能的影响因素。收集患者作答后的满意度量表并统计分析。结果 84例寄回了量表,总体满意度78.57%,13个单项满意度分别为平地行走89.26%、住院期间医护人员的服务态度84.52%、经治医生术前谈话签字内容与过程83.33%、消除关节僵硬感80.95%、疼痛缓解79.76%、恢复家务73.80%、术后改善跛行72.62%、术后住院天数70.24%、关节活动度66.67%、快走或慢跑64.29%、下楼梯59.52%、上楼梯57.14%、下蹲53.57%。其中参加运动的频率、术前伴发疾病、是否按照医师要求康复锻炼、术后并发症、术后最大活动量为满意度的影响因素。结论单侧膝关节多发韧带损伤行手术治疗患者总体满意度较高,单项满意度中平地行走最高,下蹲最低。     

Arthroscopy in injuries of the knee joint in children

The author analyses his experience in performing arthroscopy in 51 children with injuries of the knee joint. 21 patients had haemarthroses of the knee joint. Arthroscopy revealed avulsion of radiopaque osteochondrous fragments in 8 of them. Arthroscopy was performed in 15 children with knee joint blocks. Meniscus injuries were revealed in 5 children and avulsions of the osteochondrous fragments were determined in 5 patients. 9 cases of posttraumatic synovitis of the knee joint were investigated; in 3 cases there were avulsions of the osteochondrous fragment and in 3 cases there was systemic pathology. Arthroscopy as a therapeutic measure was performed in 26 children. The indications for using this method are discussed.     

Surgical treatment of chronic ligament injuries of the knee joint

Treatment for median knee-joint instability with a case history long time back may occasionally be time-consuming and dissatisfactory to patient and doctor. Several synthetic materials and autologous grafts are used in surgical therapy. Some of the methods are described in this paper. In one of them use of autologous tissue is combined with its "dynamisation".