生物可降解活性材料修复兔桡骨缺损的实验研究

目的 探讨用可降解多孔块状聚己内酯（PCL）作为骨形态发生蛋白（BMP）的载体,修复骨缺损的可行性。方法 采用兔桡骨骨缺损模型,用上述具有生物活性复合材料修复骨缺损,同时对照单纯PCL及同种异体脱钙骨,经不同的时间的X线片、X线计量学、组织形态学及电镜观察,了解PCL／BMP复合物的成骨作用。结果 PCL／BMP组不同时间新骨形成的量均优于单纯PCL组,其骨缺损修复的方式和速度与同种异体脱钙骨较相似。电镜观察表明,PCL的降解过程与单纯PCL组相比较,PCL／BMP组的降解速度较快,更符合骨缺损愈合的需要。结论 PCL是BMP的良好载体,有修复骨缺损的临床应用可行性。     

Primary repair of the cruciate and collateral ligaments after traumatic dislocation of the knee

The management of traumatic dislocation of the knee in 40 patients (41 knees) with a mean age of 26.3 years is described. They were treated by primary repair and reconstruction with autologous grafting of the anterior (ACL) and posterior cruciate ligaments (PCL) and repair injuries to the collateral ligament and soft-tissue. The ACL and PCL were reconstructed using the patellar tendon and the gracilis and semitendinosus tendons, respectively. Early mobilisation using a continuous-passive-movement machine and active exercises was started on the second day after operation. At a mean follow-up of 39 months no patient reported 'giving way' and all except one had good range of movement. Of the 41 knees, 21 were rated as excellent, 15 good, four fair and one poor. Early reconstruction of the cruciate ligaments and primary repair of the collateral ligaments followed by an aggressive rehabilitation programme are recommended for these young, active patients.     

Arthroscopic posterior cruciate ligament repair for acute femoral “peel off” tears

Posterior cruciate ligament (PCL) injuries can be associated with acute and chronic morbidity. Treatment of PCL disruption is typically either nonoperative or reconstructive, using a graft substitute. We describe a minimally invasive arthroscopic technique for repair of acute PCL tears of the femoral origin. This has been referred to as the femoral “peel off” injury. The procedure makes use of arthroscopic instrumentation to provide a direct repair of the ligament back to the femoral origin. This is a very specific injury often diagnosed with magnetic resonance imaging. This technique is not applicable to interstitial or tibial insertion tears. Operative repair is achieved using accessory portals, and instrumentation to place sutures in the PCL, which are then secured via an accessory incision for fixation. The procedure and clinical experience are discussed in detail, and a case report is included. In this very select and specific type of PCL injury, repair may provide a clinically useful alternative to full PCL reconstruction.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 19, No 4 (April), 2003: pp 431–435     

Healing of a surgically created partial detachment of the posterior cruciate ligament using marrow stimulation: an experimental study in dogs

The inability of intra-articular (cruciate) ligaments to generate a substantive reparative response may preclude the primary surgical repair of such lesions. A marrow stimulation technique that provides access to a fibrin scaffold, cytokines, and mesenchymal stem cells has been shown to be successful in generating a repair response in articular cartilage. We hypothesized that a similar approach may be effective in initiating and supporting a healing response in cruciate ligament injuries. The ability to treat cruciate ligament injuries by primary repair may have significant advantages over the more extensive reconstructive procedures currently advocated. Bilateral subtotal (75% of width) lacerations were made in the proximal aspect of the posterior cruciate ligament (PCL) in 10 adult mongrel dogs. A marrow stimulation technique in which small holes were made through the femoral origin of the PCL into the marrow cavity immediately adjacent to the lesion was performed in one limb. The contralateral limb served as the non-stimulated control. Twelve weeks after surgery the extent of healing and the histological character of the repair tissue in both groups were compared. Marrow stimulation resulted in a statistically significant (P<.05) improvement in the healing of subtotal lacerations made in the PCL. The marrow-stimulated repair tissue was more cellular and had a more organized extracellular matrix than the repair tissue in the non-stimulated group. Our hypothesis was confirmed. Marrow stimulation can induce a "healing response" in intra-articular (cruciate) ligaments. This technique may have clinical applications in primary surgical repair of these structures.     

Adverse effects associated with the use of porcine cross-linked collagen implants in an experimental model of incisional hernia repair

BACKGROUND: Porcine cross-linked collagen (PermaCol, PCL; TSL, Aldershot, United Kingdom) has been proposed as permanent biomaterial in incisional hernia repair. We evaluated the biocompatibility of PCL in an established animal model. MATERIAL AND METHODS: In 10 Sprague Dawley rats, two hernias per animal were created in the abdominal wall left and right of the linea alba (1.5 cm in diameter), and the peritoneum was spared. The lesions were left untreated for 10 days, until incisional hernias developed. These defects were covered with non-perforated (out-of-the-box, n = 12) or perforated (modified; n = 8) PCL (2 x 2 cm). In a first step, 12 non-perforated implants were tested in a short-term observation period of 17 days. Eight of these non-perforated implants were fibrin sealed (0.3 mL, Tissucol; Baxter, Vienna, Austria), whereas four non-perforated implants were sutured with non-resorbable material. In a second step, perforations were added as modification to PCL to facilitate drainage of fluids, cell ingrowth, and transgression of fibrin sealant. All perforated implants were fibrin sealed and included in a long-term observation period of 3 months. The observation periods allowed the evaluation of the complete degradation of the fibrin sealant fixation after 2 weeks and of the implant integration in a chronic timeframe. Implant sites were analyzed macroscopically and histologically. RESULTS: All PCL samples elicited strong local inflammation with signs of foreign body reaction. Integration of perforated PCL appeared limited after 3 months. Three animals had to be euthanized prior to intended time points because of transcutaneous migration of implants. CONCLUSIONS: In an experimental model of incisional hernia repair, PCL does not integrate well in the abdominal wall and shows poor biocompatibility.     

A comparison of various types of fixation devices for protection of the posterior cruciate ligament against a posterior drawer force

We compared four different fixation devices to determine which offers the greatest relative protection to the posterior cruciate ligament (PCL) against elongation with an applied posterior drawer force. We designed a system to monitor and record the change in distance between an approximate origin and insertion of the PCL as known forces were applied posteriorly to the tibia with the femur fixed. Six fresh cadaver knees were used in this investigative series. They were first tested with the PCL intact, then with the PCL transected, and then with the various fixation devices applied. After comparing the results with transarticular pins and quadrilateral and anterior half-frame external fixators, we found that transarticular fixation offers significantly greater protection to the PCL. This study may prove to be helpful to the orthopaedist when selecting ancillary fixation for posterior cruciate repair or reconstruction.     

仿生修饰结合三维打印技术构建的胶原-聚己内酯支架可促进兔临界骨缺损修复

目的 构建一种具有良好生物活性和机械性能的复合支架材料胶原-聚己内酯(Collagen-polycaprolactone,Col-PCL),通过体外及体内试验验证该支架材料的生物活性及成骨活性.方法 采用三维打印技术制备三维多孔PCL支架,将胶原凝胶充分填充于PCL支架的孔洞内,通过冷冻干燥、交联处理,获得胶原三维活化...     

膝后腓肠肌内侧入路修复后交叉韧带胫骨撕脱骨折

目的 探讨膝后腓肠肌内侧入路修复膝关节后交叉韧带(PCL)胫骨撕脱骨折。方法 应用膝后腓肠肌内侧入路对11例PCL胫骨撕脱骨折行复位固定。结果 膝后腓肠肌内侧入路对修复PCL胫骨撕脱骨折。解剖层次清晰，出血量极少，不需要切断和重新缝合组织，并发症少，简便、安全、快捷、实用。结论 膝后腓肠肌内侧入路非常适于修复PCL胫骨撕脱骨折，同时也适于股骨内侧滑车后部、胫骨平台后内侧骨折复位内固定。     

Development of novel electrospun absorbable polycaprolactone (PCL) scaffolds for hernia repair applications

Introduction

Permanent/nonresorbable hernia repair materials rely on profibrotic wound healing, and repair sites are commonly composed of disorganized tissue with inferior mechanical strength and risk of reherniation. Resorbable electrospun scaffolds represent a novel class of biomaterials, which may provide a unique platform for the design of advanced soft tissue repair materials. These materials are simple, inexpensive, nonwoven materials composed of polymer fibers that readily mimic the natural extracellular matrix. The primary goal of the present study was to evaluate the physiomechanical properties of novel electrospun scaffolds to determine their suitability for hernia repair. Based on previous experimentation, scaffolds possessing ≥20?N suture retention strength, ≥20?N tear resistance, and ≥50?N/cm tensile strength are appropriate for hernia repair.

Methods

Six novel electrospun scaffolds were fabricated by varying combinations of polymer concentration (10–12?%) and flow rate (3.5–10?mL/h). Briefly, poly(ε-caprolactone) (PCL) was dissolved in a solvent mixture and electrospun onto a planar metal collector, yielding sheets with randomly oriented fibers. Physiomechanical properties were evaluated through scanning electron microscopy, laser micrometry, and mechanical testing.

Results

Scanning electron micrographs demonstrated fiber diameters ranging from 1.0?±?0.1?μm (10?% PCL, 3.5?mL/h) to 1.5?±?0.2?μm (12?% PCL, 4?mL/h). Laser micrometry demonstrated thicknesses ranging from 0.72?±?0.07?mm (12?% PCL, 10?mL/h) to 0.91?±?0.05?mm (10?% PCL, 3.5?mL/h). Mechanical testing identified two scaffolds possessing suture retention strengths ≥20?N (12?% PCL, 10?mL/h and 12?% PCL, 6?mL/h), and no scaffolds possessing tear resistance values ≥20?N (range, 4.7?±?0.9?N to 10.6?±?1.8?N). Tensile strengths ranged from 35.27?±?2.08?N/cm (10?% PCL, 3.5?mL/h) to 81.76?±?15.85?N/cm (12?% PCL, 4?mL/h), with three scaffolds possessing strengths ≥50?N/cm (12?% PCL, 10?mL/h; 12?% PCL, 6?mL/h; 12?% PCL, 4?mL/h).

Conclusions

Two electrospun scaffolds (12?% PCL, 10?mL/h and 12?% PCL, 6?mL/h) possessed suture retention and tensile strengths appropriate for hernia repair, justifying evaluation in a large animal model. Additional studies examining advanced methods of fabrication may further improve the unique properties of these scaffolds, propelling them into applications in a variety of clinical settings.     

可降解聚己内酯修复骨缺损的实验研究

目的探讨聚己内酯(polycaprolactone,PCL)修复骨缺损的能力,为组织工程骨支架材料的可行性提供依据。方法新西兰大白兔65只,双侧股骨髁制成4.5mm×12mm的骨缺损动物模型。将PCL圆柱体植入到右侧骨缺损为实验组(n=60),羟基磷灰石(hydroxyapatite,HA)植入左侧骨缺损为对照组(n=60),空白组不植入任何物质(n=5)。于术后3、6、9和12个月将实验组及对照组取材进行大体观察、X线摄片、骨密度测定、99mTc-MDP扫描γ-显像比值测定及扫描电镜观察。空白组于术后12个月取材行大体观察。结果术后各时间点大体标本及X线片检查显示:实验组随着PCL材料的降解,骨缺损逐步被增生的骨质填充,无迟发性炎性反应出现;对照组无骨组织形成,为结缔组织充填;空白组大体观察缺损区未发现骨组织形成。骨密度测定表明:实验组骨密度增加,在各时间点与对照组比较有统计学意义(P<0.05)。99mTc-MDP扫描γ-显像显示:实验组比对照组有更多的放射性核素聚集。扫描电镜观察:术后12个月,实验组随着PCL材料的逐步降解,PCL纤维移行处界面形成较多的密质骨样组织;对照组HA-组织之间可见较多的排列不规则的胶原纤维包绕。结论PCL材料具有良好的生物相容性、缓慢降解和骨引导能力,可修复骨缺损。     

Porous tantalum and poly‐ε‐caprolactone biocomposites for osteochondral defect repair: Preliminary studies in rabbits

Currently, various techniques are in use for the repair of osteochondral defects, none of them being truly satisfactory and they are often two step procedures. Comorbidity due to cancellous bone harvest from the iliac crest further complicates the procedure. Our previous in vitro studies suggest that porous tantalum (TM) or poly‐ε‐caprolactone scaffolds (PCL) in combination with periosteal grafts could be used for osteochondral defect repair. In this in vivo study, cylindrical osteochondral defects were created on the medial and lateral condyles of 10 rabbits and filled with TM/periosteum or PCL/periosteum biosynthetic composites (n = 8 each). The regenerated osteochondral tissue was then analyzed histologically, and evaluated in an independent and blinded manner by five different observers using a 30‐point histological score. The overall histological score for PCL/periosteum was significantly better than for TM/periosteum. However, most of the regenerates were well integrated with the surrounding bone (PCL/periosteum, n = 6.4; TM/periosteum, n = 7) along with partial restoration of the tidemark (PCL/periosteum, n = 4.4; TM/periosteum, n = 5.6). A cover of hyaline‐like morphology was found after PCL/periosteum treatment (n = 4.8), yet the cartilage yields were inconsistent. In conclusion, the applied TM and PCL scaffolds promoted excellent subchondral bone regeneration. Neo‐cartilage formation from periosteum supported by a scaffold was inconsistent. This is the first study to show in vivo results of both PCL and TM scaffolds for a novel approach to osteochondral defect repair. © 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 28:141–148, 2010     

Arthroscopic Fixation of Avulsion of the Posterior Cruciate Ligament From Femoral Insertion

Femoral avulsion of the posterior cruciate ligament (PCL) is not common, especially in adults. We present a case and an arthroscopic repair technique using 4 transfemoral tunnels; 2 anterior tunnels for fixation of the anterior bundle of the PCL and 2 posterior for the posterior bundle. Our case was that of a femoral avulsion of the PCL associated with tibial avulsion of the anterior cruciate ligament and femoral avulsion of the medial collateral ligament of the left knee in an adult. We repaired the tibial avulsion of anterior cruciate ligament using an arthroscopic transtibial suture technique and the femoral avulsion of the medial collateral ligament by using staple fixation.     

膝关节多发韧带损伤的修复与重建

目的 探讨关节镜下重建膝关节前十字韧带(anterior cruciate ligament,ACL)、后十字韧带(posterior cruciate ligament,PCL)、后内侧韧带结构(posteromedial complex,PMC)或后外侧韧带结构(posterolateral complex,PLC)损伤的疗效.方法 2005年3月至2007年5月,43例膝关节多发韧带损伤患者采用异体肌腱于关节镜下重建ACL和PCL,同期重建增强PMC或PLC损伤.其中24例行ACL和PCL重建+PMC重建,19例行ACL和PCL重建+PLC重建.根据国际膝关节文献委员会(International Knee Documentation Committee,IKDC)评分和Lysholm膝关节功能评分表对患膝功能进行评估.结果 全部患者随访24～48个月,平均(33.10±9.65)个月.患者在0°和20°应力测试时稳定性均完全恢复.IKDC评分入院时均为显著异常(D级),术后随访时正常(A级)29例(67%,29/43)、接近正常(B级)11例(26%,11/43)、异常(C级)3例(7%,3/43).患者术前Lysholm膝关节功能评分为(46.7±4.2)分,末次随访时为(89.6±2.8)分,差异有统计学意义(t=8.563,P＜0.01).结论 膝关节多发韧带损伤可于关节镜下行ACL和PCL联合重建,同期行关节外韧带结构修复增强,能有效恢复关节功能,治疗效果满意.

Abstract：

Objective To describe the surgical technique and outcomes of arthroscopic reconstruction anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) and repair of the injured posteromedial complex (PMC) or posterolateral complex (PLC) structures of the knee joint in treatment of multiple ligaments injuries of knee. Methods From March 2005 to May 2007, 43 patients with multiple ligaments injuries of knee underwent arthroscopic reconstruction. Twenty-four patients were treated with arthroscopic reconstruction of combined ACL and PCL with allograft tendons and augmentation of PMC. The other 19 patients were treated with repair the PLC in addition to reconstruction of ACL and PCL. The International Knee Documentation Committee (IKDC) and Lysholm knee score were used for function evaluation. Results All patients were followed up for 24 to 48 months with an average of 33.10±9.65 months. The stability recovered when stress was applied to the knee at 0° and 20° of flexion. According to IKDC there was a significant improvement from severely abnormal (graded D) in 43 cases before surgery to normal (graded A) in 29 cases (67%), nearly normal (graded B) 11 cases (26%) and abnormal (graded C) 3 cases (7%) at follow-up. The average Lysholm score of the all cases were 46.7±4.2 and 89.6±2.8 before operation and at final follow-up, respectively (t=8.563, P＜0.01). Conclusion Excellence clinical results and good stability were achieved with arthrescopic reconstruction of ACL and PCL combined with repair or augmentation of the PMC and PLC simultaneously.     

膝关节多韧带损伤的临床研究

目的探讨膝关节多韧带损伤的诊断与治疗方法并评价其治疗效果。方法治疗51例单侧膝关节多韧带损伤,其损伤类型：21例前交叉韧带（ACL）＋内侧副韧带（MCL）,1例ACL＋后外侧复合体（PLC）,4例后交叉韧带（PCL）＋MCL,6例PCL＋PLC,6例ACL＋PCL＋MCL,3例ACL＋PCL＋PLC,8例ACL＋PCL,2例PCL＋髌腱。14例急性Ⅲ度MCL和3例急性Ⅲ度PLC损伤行切开手术,原位缝合,外固定制动3周,再行关节镜下其他韧带手术。2例Ⅲ度慢性MCL和3例Ⅲ度慢性PLC损伤行切开韧带重建术,并同期行关节镜下ACL或PCL重建术。在总共39条ACL损伤中,20条行关节镜下自体Hamstring腱ACL重建术,17条行关节镜下自体骨-髌腱-骨（BPB）重建ACL术,2条行同种异体肌腱重建ACL;在总共29条PCL损伤中,19条行关节镜下自体Hamstring腱PCL重建术,2条行同种异体肌腱重建PCL,另8条急性损伤经固定后由Ⅲ度变为〈Ⅱ度损伤,故未特别治疗。其中,17例ACL＋PCL损伤处理方法为：4例先行PCL重建,二期再行ACL的重建,7例同期自体Hamstring腱重建PCL、自体BPB重建ACL,2例为同种异体肌腱同期重建ACL和PCL,4例仅做ACL重建术。1例髌腱完全性断裂原位修复,另1例部分性髌腱损伤者未治疗。4例合并腓总神经损伤均未做特别治疗。结果平均随访2.4年（9个月～5年）。术后Lysholm评分平均为86.3（51～100）,Tegner活 动评分为5.2（2～8）,均较术前显著增加（P〈0.001）。1例外翻试验为2＋,2例Lachman试验或轴移试验≥2＋,6例应力后沉征或后抽屉试验2＋,4例内翻试验或反轴移试验2＋。其余的对应各种体格检查均为≤1＋。4例合并腓总神经损伤者,术后3例自行恢复,1例未恢复。结论在多韧带损伤中,≤Ⅱ度的MCL或者PLC损伤应采用保守治疗,Ⅲ度损伤者应尽早手术原位修复内侧副韧带及其关节囊或PLC,以利于后期进行其他重要韧带的治疗。交叉韧带或关节内重要组织可二期在?     

A novel approach to fix an avulsion fracture of posterior cruciate ligament from the tibia when associated with a type C distal femoral fracture and a Hoffa fracture: a case report

Isolated avulsion fractures of the posterior cruciate ligament (PCL) from the tibia are uncommon. Further rare, are its association with a type C distal femoral fracture and a Hoffa fracture. Arthroscopic and open methods have been described to treat the tibial avulsion of PCL. We report a novel approach to repair the tibial avulsion of PCL when associated with a type c distal femoral fracture and a Hoffa fracture. We are not aware of any similar reports in the literature.     

Acute and chronic management of posterolateral corner injuries of the knee

Isolated injury to the PLC of the knee is rare. More commonly seen is injury to the PLC combined with other ligamentous and bony knee injuries, such as ACL and PCL tears and tibial plateau fractures. Prompt recognition and treatment of PLC injuries is important as failure to do so can compromise the success of PLC repair or reconstruction, as well as the success of associated ACL or PCL reconstructions. Clinical management of the PLC is dictated by the severity of injury and timing of diagnosis. A general treatment algorithm can be followed based on grade of injury, but individualized treatment is necessary for each patient and must be based on an understanding of the biomechanics of the injury and of surgical principles.     

Knee dislocations: is reconstruction of the posterior cruciate ligament crucial?

The purpose of the present study was to investigate our 6–10 year results for knee dislocations with posterolateral corner (PLC) involvement, where a primary repair was performed laterally, the anterior cruciate ligament (ACL) reconstructed, but the posterior cruciate ligament (PCL) was left without surgery. Four consecutive patients with knee dislocation with complete rupture of the ACL, the PCL and the PLC were operated on by the same surgeon with similar technique. There were no other major injuries. We used strict inclusion criteria to get as homogenous population as possible. The ACL injuries were reconstructed and the PLC primary repaired, but the PCLs were not reconstructed. After 1–5 years, KOOS, EQ5D and work performance were recorded. Five years later these scores were repeated, with addition of the Lysholms and Tegners, standing radiographs and posterior stress radiographs. All patients were working fulltime from 1 year postoperatively onwards. One patient had returned to high-level sports activities, but the other three had lowered their activity. One patient had slight joint space narrowing at standing radiographs, but the other three appeared normal. All patients had increased posterior laxity with stress radiographs, and the tibiae were positioned more posterior with standard standing radiographs. Patients with knee dislocations where the PCL had not been reconstructed performed fairly good after more than 6 years. This study does not show that leaving the PCL in a dislocated knee is better than reconstructing it, but it may be an acceptable option.     

膝关节后交叉韧带合并后外侧角结构损伤的联合重建

目的 探讨膝关节后交叉韧带(PCL)合并后外侧角结构(PLC)实质部损伤时进行联合重建的必要性,介绍使用关节镜下5～6股腘绳肌腱单束重建膝PCL以及采用中1/3股二头肌腱、股薄肌重建PLC的技术和优点. 方法 自2001年1月至2006年12月,收治膝关节PCL合并PLC损伤患者28例,均为PCL损伤≥Ⅱ°b、PLC损伤>Ⅱ°.X线片有韧带附着点撕脱骨折及严重内翻不稳需要胫骨截骨者不计入本组.治疗方法:手术治疗28例,其中2002年1月至2003年12月间8例行关节镜下腘绳肌腱单束重建PCL,而PLC保守治疗;2002年1月至2006年12月间20例关节镜下修复重建PCL,再开放手术操作修复重建PLC结构. 结果 随访6～24个月,平均15个月.功能评定按照Lysholm标准,单纯修复PCL组中等3例,差5例;PCL和PLC联合重建者中优良19例,中等1例.两组的Lysholm评分平均为(47.1±8.2)分和(86.7±7.2)分,差异有统计学意义(t=19.277,P<0.05);IKDC评估两组分别有3例和19例对手术结果满意.无严重并发症发生. 结论 膝关节PCL合并PLC损伤可造成患肢严重的无法代偿的功能损害,手术时应当进行联合重建,忽视PLC重建的重要性,会导致PCL重建效果下降或失败;采用关节镜下5～6股腘绳肌腱单束重建膝PCL以及采用中1/3股二头肌腱、股薄肌重建PLC的技术治疗PCL合并PLC损伤取得较好的临床效果.     

Ⅰ期关节镜辅助下修复重建膝关节后外侧脱位合并多发韧带损伤的疗效观察

目的：评估采用Ⅰ期关节镜辅助下重建前后交叉韧带（ACL/PCL）及修复膝后内侧韧带结构的方法,治疗膝关节后外侧脱位的临床效果.方法：自2008年3月至2012年8月,收治膝关节后外侧脱位22例.男16例,女6例;年龄20～53岁,平均30.5岁;运动伤8例,车祸伤5例,摔伤9例.前交叉韧带重建均使用自体半腱肌、股薄肌肌腱;后交叉韧带重建使用LARS人工韧带14例,自体半腱肌、股薄肌肌腱8例;膝后内侧韧带结构损伤行缝合修复17例,行自体半腱肌加强术5例;手术均为Ⅰ期完成.术后早期行CPM及主动活动训练.采用国际膝关节文献委员会IKDC分级及Lysholm评分评估疗效.结果：术后患者均获随访,时间11～56个月,平均39个月.术后膝关节IKDC评定：A级9例,B级10例,C级3例;末次随访IKDC评分89.6±3.1.末次随访Lysholm评分90.7±1.8,术后较术前评分改善.结论：关节镜下Ⅰ期重建前后交叉韧带及修复其他膝后内侧韧带结构,并辅以积极功能锻炼,能较好恢复关节稳定性,临床效果满意,是治疗膝后外侧脱位的一种有效方法.     

Natural history of the posterior cruciate ligament-deficient knee

This paper documents the clinical course of the posterior cruciate ligament-deficient knee. By obtaining an understanding of the natural history of this lesion, the indications for surgical repair, reconstruction, and conservative treatment will be more clearly defined, and the clinician will be able to more critically evaluate the results of both acute repair and reconstruction of this ligament. Forty-three patients with an average interval of 6.3 years (range, one to 37 years) between injury and evaluation were included in this study. Fourteen patients had a straight unidirectional posterior instability and 29 had a combined multidirectional instability. The follow-up evaluation included functional assessment, physical and roentgenographic evaluation, arthrometric laxity measurement, and isokinetic dynametric testing of quadriceps function. Statistical treatment of the data, utilizing both nonparametric methods and logistic modeling, clearly delineated the natural history of the injury to the posterior cruciate ligament (PCL). It was established that the functional outcome can be predicted on the basis of the instability type. Specifically, those knees with PCL disruption without associated ligamentous laxity will probably remain symptom-free. However, when PCL disruption is associated with combined instabilities, a less than desirable functional result will probably occur. Application of logistic modeling to the data demonstrated that the functional result was not due to the type of instability per se, but rather to associated factors, i.e., chondromalacia of the patella, meniscal derangement, quadriceps atrophy, or degenerative changes. A direct correlation has been established between combined multidirectional instability and the occurrence of those associated secondary problems resulting in the patient's complaints and functional disability.(ABSTRACT TRUNCATED AT 250 WORDS)