不同后交叉韧带指数测量方法对前交叉韧带损伤的诊断价值

目的:比较6种不同测量方法下的后交叉韧带(posterior cruciate ligament,PCL)指数(Index),分析验证其在前交叉韧带(anterior cruciate ligament,ACL)损伤中的临床诊断价值。方法:回顾性分析2018年5月至2022年3月收治的225例患者的膝关节MRI资料,年龄18～60岁,中位数32岁。根据ACL是否损伤,分为ACL正常组和ACL损伤组。在114例ACL损伤和111例ACL完整受试者的膝关节MRI矢状位图像上,测量MRI矢状位PCL在股骨附着点和胫骨附着点之间的直线距离(A)和该直线到矢状位图像上PCL弧形标记点之间的最大垂直距离(B),计算PCL Index并评估其对ACL损伤的诊断价值。结果:ACL正常组和ACL损伤组PCL Index1、2、3、6比较差异无统计学意义(P>0.05);两组PCL Index4、5比较,差异有统计学意义(P<0.001)。ACL正常组的PCL Index2、6与患者年龄呈负相关性(相关系数=-0.213,-0.189;P<0.05),ACL损伤组的PCL Index5与...     

膝关节后内侧结构损伤合并单一交叉韧带断裂的早期治疗

目的 探讨膝关节后内侧结构损伤合并单一交叉韧带断裂进行早期手术的疗效.方法 2002年1月至2005年12月共治疗12例后内侧结构损伤合并单一交叉韧带断裂患者,其中10例合并前交叉韧带(ACL)断裂,2例合并后交叉韧带(PCL)断裂.交叉韧带损伤术前Lysholm评分为50～60分(平均56.7分).关节镜下重建交叉韧带,开放修复后内侧结构.8例采用自体半腱肌、股薄重建ACL(transfix术式),2例采用骨.髌腱.骨重建ACL.2例采用一端带骨块的异体跟腱蓖建PCL.后内侧结构损伤修复:8例采用星状钢板螺钉同定,2例采用GⅡ锚钉固定.1例采用自体半肌腱、股薄肌移植重建,1 例采用端对端缝合.结果 12例中除2例随访4个月后失访外,其余10例患者术后获平均12个月(6～18个月)随访.交叉韧带损伤重建后Lysholm评分为74～94分(平均81.2分).后内侧结构修复后10例膝伸屈范围正常,2例伸直受限5.外翻应力试验于O啦时,9例正常,2例弱阳性(+),1例阳性(++).结论 膝后内侧结构损伤合并单一交叉韧带断裂时,早期重建交叉韧带同时一期修复膝后内侧结构可以较好地恢复膝关节稳定性.     

The diagnostic accuracy of anterior cruciate ligament rupture using magnetic resonance imaging: a meta-analysis

This study evaluates the diagnostic accuracy of anterior cruciate ligament (ACL) rupture using magnetic resonance imaging in the management of patients with symptomatic tibiofemoral instability. Published and unpublished databases including the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, AMED and CINAHL, as well as unpublished studies registers were searched for studies that compared the diagnostic findings of MRI to arthroscopic surgery for patients with a suspected ACL rupture in September 2010. For each study, sensitivity and specificity of complete ACL rupture were analysed as bivariate data to account for a possible negative correlation within studies, and pooled meta-analysis was performed. Fifty-three studies compared the diagnostic accuracy of MRI to arthroscopic findings for a total of 4,673 patients, 4,683 knees. Overall, the pooled sensitivity of MRI for detecting complete ACL rupture was 94.5% (95% confidence interval 0.92–0.96) and specificity of 95.3% (0.93–0.97). MRI has high accuracy for patients with complete ACL rupture. Due to the higher economic costs and increased complication risks of diagnostic arthroscopy, MRI is therefore recommended as the principal investigation following clinical examination, to diagnose ACL rupture.     

Meniscal tears sustained awaiting anterior cruciate ligament reconstruction

We reviewed 68 patients who underwent anterior cruciate ligament (ACL) reconstruction after initial EUA & arthroscopy in the knee unit of a United Kingdom district general hospital. Mean time between injury and ACL reconstruction surgery was 23.3 months with the incidence of meniscal tear at reconstruction being 67.6%. In this series 10.3% of patients sustained a meniscal tear in the delay period between arthroscopy and reconstruction surgery. Meniscal tear is strongly associated with ACL rupture and also a poorer outcome following reconstruction surgery. The delay in diagnosis and wait for reconstruction surgery that patients experience are potentially worsening surgical outcomes in the anterior cruciate deficient knee.     

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     

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。     

Diagnostic and incidence of the rupture of the posterior cruciate ligament

Summary The purpose of this article is to evaluate the incidence and to give a general review of the examination of the posterior ligament complex. At least ca. 8–10 % of all severe ligament injuries concern the posterior cruciate ligament, which means, that an estimated 4000–5000 Germans suffer a PCL rupture every year. Motor-vehicle accidents are the most common cause of the injury, but sports-related traumas (football, skiing) have increased in recent years. The high number of high-energy mechanisms involved (up to 90 %), cause ligament ruptures often to be associated with other injuries, especially fractures of the femur and tibia head. In polytrauma patients PCL ruptures are frequently recognized very late, because the possibility of this kind of injury is often not considered during the clinical examination. The same holds for the diagnosis of monotrauma patients. The initial step in the evaluation is to obtain a thorough history (including the mechanism of injury) and to perform a physical examination. The instability after a PCL rupture may present as an ACL rupture, because the anterior drawer test seems to be positive. The anterior/posterior drawer test must be assessed with other evaluation procedures to distinguish between anterior und posterior instabilities. The posterior sag sign, the quadriceps active test or the reversed pivot-shift may indicate a PCL rupture. A correct roentgenogram can reveal an avulsion of the tibia and can prove posterior instability due to a posterior translation of the tibia. A quantitative examination (clinical or X-ray) of the instability and the indication of combined injury of the posterior cruciate ligament and the posterolateral complex are necessary for the therapeutic decision (operative/conservative). A rupture of the PCL may occur occasionally as a result of a luxation of the knee (reduced spontaneously) before the medical evaluation. A thorough neurovascular examination is essential. Magnetic resonance imaging can be important to the diagnosis of an acute injury, but it is not essential for the choice between operative and non-operative treatment. Arthroscopy has been found to have a high degree of accuracy in the diagnosis of ligament ruptures of the knee, but it is still an operative treatment, so that it can only be used if an operation of repair or reconstruction is planned anyway. Before operative treatment of chronic complex instability, potential osseous abnormalities (varus morphotype) must be revealed; in case of uncertainty, an X-ray control is necessary.      

Diagnostic and incidence of the rupture of the posterior cruciate ligament

The purpose of this article is to evaluate the incidence and to give a general review of the examination of the posterior ligament complex. At least ca. 8–10 % of all severe ligament injuries concern the posterior cruciate ligament, which means, that an estimated 4000–5000 Germans suffer a PCL rupture every year. Motor-vehicle accidents are the most common cause of the injury, but sports-related traumas (football, skiing) have increased in recent years. The high number of high-energy mechanisms involved (up to 90 %), cause ligament ruptures often to be associated with other injuries, especially fractures of the femur and tibia head. In polytrauma patients PCL ruptures are frequently recognized very late, because the possibility of this kind of injury is often not considered during the clinical examination. The same holds for the diagnosis of monotrauma patients. The initial step in the evaluation is to obtain a thorough history (including the mechanism of injury) and to perform a physical examination. The instability after a PCL rupture may present as an ACL rupture, because the anterior drawer test seems to be positive. The anterior/posterior drawer test must be assessed with other evaluation procedures to distinguish between anterior und posterior instabilities. The posterior sag sign, the quadriceps active test or the reversed pivot-shift may indicate a PCL rupture. A correct roentgenogram can reveal an avulsion of the tibia and can prove posterior instability due to a posterior translation of the tibia. A quantitative examination (clinical or X-ray) of the instability and the indication of combined injury of the posterior cruciate ligament and the posterolateral complex are necessary for the therapeutic decision (operative/conservative). A rupture of the PCL may occur occasionally as a result of a luxation of the knee (reduced spontaneously) before the medical evaluation. A thorough neurovascular examination is essential. Magnetic resonance imaging can be important to the diagnosis of an acute injury, but it is not essential for the choice between operative and non-operative treatment. Arthroscopy has been found to have a high degree of accuracy in the diagnosis of ligament ruptures of the knee, but it is still an operative treatment, so that it can only be used if an operation of repair or reconstruction is planned anyway. Before operative treatment of chronic complex instability, potential osseous abnormalities (varus morphotype) must be revealed; in case of uncertainty, an X-ray control is necessary.     

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。     

膝关节镜下微创重建前交叉韧带

为使膝关节前交叉韧带重建手术定位准确,固定更加牢固和早期功能康复,同时减少手术创伤。1997年10月至1999年4月应用膝关节镜下挤压螺钉固定骨-髌腱(中1/3)-骨自体移植重建前交叉韧带的新技术,重建前交叉韧带74例,并取得良好效果。结果 表明该方法手术创伤小,骨道定位准确,能做到等长重建。由于充分利用了髌腱这一较为理想的自体材料,两端带有骨块,重建的韧带最终可达到牢固的生物学固定。作根据临床实践,结合全部病例,重点总结介绍了关节镜下重建前交叉韧带的临床技术和经验。     

Diagnosis of anterior cruciate ligament injury of the knee joint]

From January, 1979 to May, 1989, 107 patients with problems related to anterior cruciate ligament (ACL) were treated in our hospital. 100 of the patients had anterior cruciate ligament injury confirmed by arthrotomy or arthroscopy. The remaining 7 patients were found to be normal either by arthroscopy or arthrotomy. 29 patients had fresh ACL injury and 71 old. All the patients had history of trauma of the knee joint. Swelling and pain in the affected knee joint took place in fresh cases and few of them complained of instability or deformity of the knee. On examination, floating patella test was positive in the majority of the fresh cases. It was shown that accurate diagnosis could be made by Lachman test rather than by conventional anterior drawer test in dealing with fresh injury, but with old ones, Lachman test didn't show the advantages. Examination under anesthesia or arthroscopy helped a lot in diagnosing fresh ACL injury. Anterior drawer test (ADT) was significant in determining the existence of ACL injury. When ADT was positive, ACL injury was found in the majority of the cases, however, injured ACL couldn't be ruled out by negative ADT only. Positive valgus stress test on 0 degrees position suggests possibility of ACL injury, even ADT was negative. Despite the negative anterior drawer test positive posterior drawer test on three directions indicated the injury of the posterior cruciate ligament and the anterior cruciate ligament. The positive rate of ADT was higher than that of pivot shift test in dealing with anterior cruciate ligament injury. Positive pivot shift test suggests ACL injury.     

膝关节后交叉韧带损伤的临床流行病学分析

目的:研究膝关节后交叉韧带损伤的临床特点及其分布规律.方法:回顾性分析2006年1月至2013年6月确诊的326例膝关节后交叉韧带损伤患者临床资料,将病例按损伤类型分组,对性别、侧别、年龄、受伤原因、受伤至就诊时间、合并损伤等因素进行分析,同时比较不同类型后交叉韧带损伤的个体化因素及合并损伤情况.结果:后交叉韧带损伤患者男性占73％,30～50岁是发病高峰(59％),患者多于伤后1个月内就诊(62.6％);受伤原因以交通伤为主(59％);合并损伤中前交叉韧带损伤最多(46.9％),其次为内侧副韧带(29.8％)和后外侧角(26.1％);后交叉韧带实质部损伤较止点撕脱骨折多,发生合并损伤的概率也较后者高(P＜0.05),受伤原因差异也具有统计学意义(P＜0.05);单纯止点撕脱骨折与单纯实质部损伤在发生率和就诊时间方面差异具有统计学意义(P＜0.05).结论:后交叉韧带损伤以实质部损伤为主,合并损伤率较高,以ACL损伤最常见;止点撕脱骨折以胫骨侧为主,多由低能量暴力导致,合并损伤较少;实质部损伤多由高能量暴力所致,多有合并损伤;单纯止点撕脱骨折发病率较单纯实质部损伤高.     

早期关节镜下同种异体骨-腱-骨重建前后交叉韧带急性损伤

目的探讨同种异体骨-腱-骨（B-PT-B）同时重建膝关节前交叉韧带（ACL）、后交叉韧带（PCL）急性损伤的临床疗效。方法在关节镜下早期使用同种异体B-PT-B重建ACL、PCL急性损伤患者22例。结果22例均获随访,时间1618个月。患者屈膝范围从术前7990（85.5±4.5）°提高到术后134140（138±1.5）°,Lysholm膝关节功能评分从术前023（8.6±3.0）分提高到术后8596（92.0±3.6）分（P〈0.01）。未发现感染、移植物断裂、排异反应等。结论早期关节镜下应用同种异体B-PT-B重建ACL、PCL急性损伤,具有手术操作简便、创伤小、免疫排斥反应小、术后并发症少的优点,能最大限度恢复患者膝关节的本体感觉功能及运动功能。     

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。     

关节镜下部分重建治疗膝关节前交叉韧带不完全断裂

目的 探讨前交叉韧带(ACL)不完全断裂的关节镜下诊断及镜下部分蕈建治疗的疗效和意义. 方法 2004年6月至2006年12月,经关节镜确诊ACL不完伞断裂29例,其中前内侧束断裂21例,后外侧束断裂8例.全部患者于关节镜下重建损伤部分的韧带组织,选用LARS韧带蕈建11例,自体四股腘绳肌腱移植重建18例,术中完整保留未断裂部分的切带纤维束. 结果全部患者均获随访,平均随访15个月(12～30个月),治疗康复12个月时,门诊进行统一标准膝关节功能评定,膝关节Lysholm评分手术前、后比较差异有统计学意义(P<0.05). 结论正常ACL的前内侧束和后外侧束各自有不同的功能,对于ACL不完全断裂,准确判断ACL的断裂程度十分重要.有效地重建断裂部分的ACL,能够恢复双束韧带的完整统一,更有益于良好地恢复关节功能,避免晚期并发症的发生,对恢复膝关节稳定和功能有着重要的意义.     

Valgus medial collateral ligament rupture causes concomitant loading and damage of the anterior cruciate ligament

This study tested the hypothesis that application of a valgus force necessary to create a complete medial collateral ligament (MCL) injury causes damage to the anterior cruciate ligament (ACL). Twelve cadaveric knees were used to measure concomitant loading and damage to the ACL in valgus knee loading sufficient to cause a grade III MCL injury. Displacement sensors were placed on the anteromedial bundle of the ACL and posterior oblique ligament to monitor tensile strain during creation of the MCL injury. A valgus moment was applied to knees flexed at 30 degrees, displacing the joint into valgus rotation beyond MCL rupture. Following valgus loading and MCL injury, femur-ACL-tibia specimens were tested to failure to compare ACL mechanical integrity to noninjured control specimens. Average ACL strength in MCL ruptured knees (1250 +/- 90 N) was statistically lower (P < or = .05) than that for control knees (2110 +/- 50 N). Strain measurements exhibited concomitant posterior oblique ligament strain during valgus loading, whereas ACL strain increased substantially only after MCL rupture. These data indicate that the ACL can be compromised in isolated grade III MCL injuries.     

关节镜下前交叉韧带袖套状保残重建的临床效果

目的:观察袖套状保留残端的关节镜下前交叉韧带重建的临床效果。方法:收集2012年1月至2014年12月于骨科就诊的42例前交叉韧带损伤患者,其中男17例,女25例,平均年龄28.4岁,平均受伤时间5.5周(2~12周)。采用关节镜下重建前交叉韧带,同时保留胫骨侧韧带残端,通过滑膜袖套恢复残端张力。治疗前及治疗后2、6、12个月采用Lachman试验、前抽屉试验对稳定性进行评价,术后12个月采用Lysholm评分和Tegner运动分级评价膝关节功能。治疗前和治疗后12个月行膝关节MRI检查。结果:术后2、6、12个月Lachman试验、前抽屉试验均为阴性。术前Lysholm评分37.8±7.1,Tegner评分2.1±0.4;术后12个月的Lysholm评分96.8±6.1,Tegner评分6.2±0.9,均高于术前。术后12个月复查MRI显示前交叉韧带显影良好。结论:关节镜下前交叉韧带袖套状保残重建可以获得良好的临床效果。     

膝关节脱位多韧带损伤Ⅰ期修复重建的临床观察

目的:探讨关节镜下Ⅰ期异体肌腱重建并结合关节外微创技术治疗膝关节脱位合并多发韧带损伤的临床疗效。方法:2008年1月至2012年1月共收治48例膝关节脱位患者,排除腘血管损伤,采用关节镜下Ⅰ期重建前后交叉韧带,并结合关节外微创技术修复膝关节韧带损伤。男38例,女10例;年龄20～59岁,平均35.6岁;左膝22例,右膝26例;伤后至手术时间2 d～2周。前交叉韧带(ACL)、后交叉韧带(PCL)、内侧副韧带(MCL)及后外侧复合体(PLC)损伤2例,ACL、PCL及MCL损伤36例,ACL、PCL及PLC损伤10例。合并腓总神经损伤4例。比较术前及末次随访时Lysholm 评分以评价膝关节功能。结果:所有患者获得随访,时间12～30个月,平均(18.2±6.3)个月,患者关节活动度和稳定性明显改善,Lysholm评分由术前40.3±4.1提高为随访时87. 0±6.4.结论:关节镜下应用同种异体肌腱Ⅰ期重建膝关节脱位并多韧带损伤,能较好地恢复关节稳定性,保留关节功能。术前训练指导及术后个体化康复是膝关节功能恢复的关键。     

Preservation of anterior cruciate ligament in total knee arthroplasty

Few prostheses allow preservation of the anterior cruciate ligament (ACL) during total knee replacement. We report a short-term, prospective, open study of 32 ACL-retaining and 93 ACL-replacing total knee replacements and compare the respective outcomes of both prosthesis types with a follow-up time of 2–3 years. Mean operative time, complication or revision rates did not differ, nor did the early and late clinical and radiological evaluations. This study does not support the suggestion that technical difficulties increase for ACL preservation. The clinical and functional results were neither improved nor worsened for ACL-retaining prostheses. There is thus no advantage, but also no inconvenience, in retaining the ACL according to short- to mid-term results of a gliding posterior cruciate ligament (PCL)-retaining prosthesis with ACL-replacement design. The possibility of an improved long-term outcome of an ACL-retaining prosthesis should be investigated further. Received: 10 September 1997     

Isolated posterior cruciate ligament insufficiency induces morphological changes of anterior cruciate ligament collagen fibrils.

We studied the ultrastructural changes of the human anterior cruciate ligament (ACL) with transmission electron micrograph cross-sections following isolated posterior cruciate ligament (PCL) injury. Biopsy specimens were obtained from the proximal third and anteromedial aspect of the ACL. Fourteen patients with PCL-deficient knees at a mean of 22.1 months from injury to surgery and 5 normal knees amputated secondary to malignant tumors or traumatic injuries were used as controls. A significant difference was found in the number of collagen fibrils per 1 microm2 between the PCL-deficient knee group and the control group. There was a significant difference found in the collagen fibril diameter between the PCL-deficient knee group and the control group. The collagen packing density (the percentage of sampled area occupied by collagen fibrils) was also significantly different between the PCL-deficient knee and the control group. The current study shows that an isolated PCL insufficiency can induce morphological changes in ACL collagen fibrils, suggesting that a PCL insufficiency can have adverse effects on other ligamentous structures in the knee joint.