关节镜下一期修复重建膝关节多发韧带损伤

目的 探讨关节镜下一期修复重建膝关节多发韧带损伤的近期疗效. 方法 2009年2月至2012年4月共收治19例单侧膝关节多发韧带损伤患者,男15例,女4例;年龄为18 ～53岁,平均33.5岁.所有患者均存在前交叉韧带(ACL)、后交叉韧带(PCL)损伤,合并内侧副韧带(MCL)损伤15例,外侧副韧带(LCL)损伤3例.受伤至手术时间为10～ 18 d,平均14.1d.采用关节镜下自体胭腘肌腱修复重建ACL、PCL,用十字带线锚钉固定修复MCL和LCL. 结果 19例患者术后获6～ 24个月(平均18个月)随访.14例患者运动功能恢复至受伤前水平,4例患者得到明显改善,1例患者出现关节粘连引起僵硬.所有患者术后Lachman试验、前、后抽屉试验及膝内外翻应力试验均为阴性,胫骨前后移距离均＜5 mm.术后12个月17例患者Lysholm膝关节功能评分由术前平均(46.3±5.6)分提高至(89.0±7.0)分,差异有统计学意义(t=9.291,P＜0.001);关节活动范围由术前平均64.5°±17.5°改善至121.0°±7.2°,差异有统计学意义(t=8.020,P＜0.001).结论 对于膝关节多发韧带损伤,一期关节镜下重建ACL和PCL,同时修复MCL和LCL,可恢复膝关节的稳定性,功能恢复快,关节粘连率低,疗效较满意.     

胫骨平台骨折后漏诊的膝关节韧带损伤的诊治

目的提高对胫骨平台骨折伴膝关节韧带损伤的认识,从而降低漏诊率。方法回顾性分析2001年1月～2004年12月手术治疗的126例胫骨平台骨折患者中伴膝关节韧带损伤的15例患者。通过术后随访、临床表现、手术和MRI检查,明确是否伴有膝关节韧带损伤及膝关节明显不稳。证实存在膝关节韧带损伤者行手术治疗,内侧副韧带损伤患者行修补或“鹅足”转移成形术,前交叉韧带(ACL)损伤患者行Jones改良骨-韧带-骨重建术,后交叉韧带(PCL)损伤患者行Augustine术。结果术后患者获6～14个月(平均10个月)随访。15例胫骨平台骨折患者均伴有膝关节韧带损伤,行相应手术治疗后功能满意者12例,3例出现上、下楼梯困难,并且退变加重。结论胫骨平台骨折常伴膝关节韧带损伤,术前认识不足、术中探查不力、术后随访不到位是漏诊并遗留关节功能障碍的主要原因。     

多发韧带损伤中严重内侧副韧带断裂不同治疗方式的比较研究

目的比较多发韧带损伤中内侧副韧带缝合与重建治疗后膝关节功能差异。方法回顾分析2008年8月-2012年8月,收治的31例合并内侧副韧带断裂的膝关节多发韧带损伤患者临床资料。其中11例行内侧副韧带缝合(缝合组),20例行内侧副韧带重建(重建组)。两组患者性别、年龄、体质量、侧别、致伤原因以及术前膝关节Lyshlom评分、国际膝关节文献委员会(IKDC)膝关节主观功能评分、膝关节活动度以及膝关节内侧间隙等一般资料比较,差异均无统计学意义(P0.05)。比较两组术后膝关节功能及稳定性。结果两组术后切口均Ⅰ期愈合,无手术相关并发症发生。患者术后均获随访,随访时间2~4年,平均3.2年。两组术后2年Lyshlom评分、IKDC膝关节主观功能评分及膝关节活动度均较术前显著提高,比较差异有统计学意义(P0.05);重建组膝关节活动度优于缝合组,差异有统计学意义(P0.05);两组Lyshlom评分及IKDC膝关节主观功能评分比较,差异无统计学意义(P0.05)。两组术后前、后抽屉试验及内翻应力试验均为阴性。术后2年两组膝关节内侧间隙均恢复,与术前比较差异有统计学意义(P0.05);两组间比较差异无统计学意义(P0.05)。结论膝关节多发韧带损伤中,内侧副韧带损伤经缝合或重建治疗均能恢复膝关节内侧稳定性,但重建术后膝关节活动度优于缝合术后。     

关节镜下微创治疗膝交叉韧带损伤合并下肢深静脉血栓

目的探讨关节镜下治疗膝关节交叉韧带损伤合并下肢深静脉血栓形成的方法及近期临床疗效。方法对25例膝交叉韧带损伤合并单侧下肢静脉血栓的患者行关节镜下交叉韧带重建术。结果所有患者术后均未出现肺栓塞、感染等并发症,手术前后Lysholm与IKDC(%)评分比较差异有统计学意义(P<0.05)。结论膝关节交叉韧带损伤合并下肢深静脉血栓并非手术绝对禁忌证,术前明确诊断、早期治疗可获得较满意的疗效。     

关节镜下半月板部分切除术患者满意度调查分析

目的探讨膝关节半月板部分切除术的主观满意度与客观满意度之间的关系,及主观满意度的影响因素。方法以Lysholm评分作为膝关节半月板部分切除术客观满意度的指标,设计满意度调查问卷,通过电话回访、微信填写等方式,共收集本院自2014-04—2016-04关节镜下行半月板部分切除术的患者共109例。结果术前术后Lysholm评分差异有统计学意义;其中交锁、膝关节稳定情况、上下楼梯情况、下蹲情况是影响因素;主观满意度与术前是否充分了解手术、对护理满意情况、是否达到术前期望、骨科水平主观认可程度、术后功能、改善日常活动、康复指导、康复过程、症状是否消失等因素有关;结论主观满意度的影响因素有:交锁、膝关节稳定情况、上下楼梯情况、下蹲情况、术前是否充分了解手术、对护理满意情况、是否达到术前期望、骨科水平主观认知、术后功能、改善日常活动、康复指导、康复过程、症状是否消失。     

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.     

膝关节多发韧带损伤脱位伴腘动脉损伤三例

目的总结3例膝关节多发韧带损伤脱位伴腘动脉损伤的诊疗经验。方法2011年10月—2018年2月,收治3例膝关节多发韧带损伤脱位伴腘动脉损伤男性患者。患者年龄分别为27、70、31岁。损伤累及双侧1例、单侧2例。血管损伤时间10、4、3 h。采用一期修复血管、二期修复韧带治疗。结果患者住院时间分别为30、5、10周,随访时间为9.5、3.5、3.0年。1例患者血管修复术后下肢皮肤、皮下组织部分坏死结痂,经再次植皮后愈合;其余患者切口均Ⅰ期愈合。所有肢体均成活,随访期间无感染、血管再损伤或新鲜血栓形成。末次随访时膝关节功能恢复良好,Tegner评分、Lysholm评分及美国特种外科医院(HSS)评分均较术前明显改善。1例合并双侧腘动脉损伤者并发双侧跟腱挛缩,1例术后膝关节不稳复发再次手术。结论膝关节多发韧带损伤脱位伴血管损伤临床较少见,多学科协作、及早发现和评估血管损伤、优先处理腘动脉损伤逆转肢体缺血及固定肢体是治疗此类损伤的有效方法,能够保存肢体并改善膝关节功能。     

膝关节多发韧带损伤脱位伴腘动脉损伤三例北大核心CSCD

目的总结3例膝关节多发韧带损伤脱位伴腘动脉损伤的诊疗经验。方法2011年10月—2018年2月,收治3例膝关节多发韧带损伤脱位伴腘动脉损伤男性患者。患者年龄分别为27、70、31岁。损伤累及双侧1例、单侧2例。血管损伤时间10、4、3 h。采用一期修复血管、二期修复韧带治疗。结果患者住院时间分别为30、5、10周,随访时间为9.5、3.5、3.0年。1例患者血管修复术后下肢皮肤、皮下组织部分坏死结痂,经再次植皮后愈合;其余患者切口均Ⅰ期愈合。所有肢体均成活,随访期间无感染、血管再损伤或新鲜血栓形成。末次随访时膝关节功能恢复良好,Tegner评分、Lysholm评分及美国特种外科医院(HSS)评分均较术前明显改善。1例合并双侧腘动脉损伤者并发双侧跟腱挛缩,1例术后膝关节不稳复发再次手术。结论膝关节多发韧带损伤脱位伴血管损伤临床较少见,多学科协作、及早发现和评估血管损伤、优先处理腘动脉损伤逆转肢体缺血及固定肢体是治疗此类损伤的有效方法,能够保存肢体并改善膝关节功能。     

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。     

膝关节内侧副韧带损伤所致关节伸直受限的康复治疗

[目的]探讨膝关节内侧副韧带损伤所致关节伸直受限原因及康复治疗方法。[方法]收集2013年7月~2014年6月于本院门诊治疗的35例膝关节内侧副韧带损伤所致关节伸直受限患者。通过康复治疗方法治疗,并对治疗前后效果进行评估。[结果]35例患者均获得一年随访,膝关节均达到屈伸正常。治疗后患者膝关节活动范围良好;膝关节力线正常;关节稳定性良好。股四头肌抗阻力测定为4级,部分患者股四头肌的抗阻力检测可达5级。MRI随访见内侧副韧带损伤部位均存在自愈现象。关节活动度治疗前后比较差异有统计学意义(P0.05)。[结论]尽早使膝关节恢复伸直状态是治疗成功的关键,通过康复治疗,可以使单纯膝关节内侧副韧带Ⅱ~Ⅲ度损伤患者的膝关节活动度达到正常水平,避免手术治疗,也可以为单纯内侧副韧带后角Ⅲ度以上损伤或内侧副韧带后角损伤的患者,以及内侧副韧带损伤合并前交叉韧带损伤或后交叉韧带损伤的患者后期重建手术及术后康复提供有利条件及基础。     

Comparison of outcome after ACL reconstruction in terms of subjective assessment of symptoms and function and clinical assessment of ligament stability

Background

The knee joint is frequently involved in sports and other injuries with Anterior cruciate ligament being a very common ligament to be injured. The Lachman test, pivot-shift test, and instrumented knee laxity examination are frequently used and reported for evaluation of ACL reconstruction. The aim of this study is to examine and evaluate the relationships between the clinical assessment of ligament stability and subjective assessment of symptoms and function after ACL reconstruction.

Determinants of patient satisfaction with outcome after anterior cruciate ligament reconstruction

BACKGROUND: The purpose of this study was to identify the determinants of patient satisfaction with the outcome after reconstruction of the anterior cruciate ligament. METHODS: A cohort of 201 patients undergoing primary reconstruction of the anterior cruciate ligament was studied prospectively. All patients were followed for a minimum of two years (mean, 35.9 months). The dependent variable was patient satisfaction with the outcome, graded ordinally on a scale of 1 to 10. Nonparametric univariate analysis and multivariable modeling were performed to identify determinants of satisfaction. RESULTS: The demographic variables were not found to have a significant association (p > 0.05) with patient satisfaction. The variables at surgery demonstrated a significant association (p < 0.05) with patient satisfaction only with respect to the status of the lateral meniscus, the presence of osteophytes, and concurrent plica excision. The objective variables at follow-up revealed that patients were significantly less satisfied (p < 0.05) if they had a flexion contracture, increased laxity of the involved leg on the manual maximum test as measured on a KT-1000 device, an abnormal result on the pivot-shift examination, effusion, or tenderness at the medial joint line or patella. With regard to the subjective symptoms at follow-up, patients were found to be significantly (p < 0.05) less satisfied with the outcome if they had symptoms of pain, swelling, partial giving-way, full giving-way, locking, noise, stiffness, or a limp. Analysis of the subjective function at follow-up demonstrated that patients were significantly less satisfied (p < 0.05) with the outcome if they had a lower level of activity, sports activity, strenuous work, activities of daily living, overall knee function, sports participation, or symptom-free activity; if they were unemployed; or if they had difficulty with walking, squatting, ascending or descending stairs, running, jumping, cutting, or twisting. Patient satisfaction was significantly associated (p < 0.05) with the Lysholm knee score, overall International Knee Documentation Committee (IKDC) knee score, IKDC subjective subscore, IKDC symptoms subscore, and IKDC range-of-motion subscore. The seven independent multivariate determinants (adjusted R (2) = 0.83, p < 0.001) of patient satisfaction included the Lysholm score, overall subjective knee function, IKDC range-of-motion subscale, patellar tenderness, full giving-way, flexion contracture, and swelling. CONCLUSIONS: Univariate and multivariate determinants of patient satisfaction with the outcome after reconstruction of the anterior cruciate ligament were established. Although some specific surgical and objective variables were important, subjective variables of symptoms and function had the most robust associations with patient satisfaction. In assessing the outcome of reconstruction from the perspective of patient satisfaction with the outcome, we should emphasize patient-derived subjective assessment of symptoms and function, particularly those involving issues of stiffness, giving-way, swelling, and patellofemoral symptoms.     

Gait analysis 6 and 12 months after anterior cruciate ligament reconstruction surgery

Little is known about knee function after anterior cruciate ligament reconstruction in the vital activities of walking and stair use. Gait analysis was done on patients 6 months (n = 8) and 12 months (n = 9) after reconstruction of the anterior cruciate ligament. Paired t tests were used to compare the injured and uninjured knees. During level walking, the patients placed external flexion torques on their injured knees throughout midstance, indicating the absence of quadriceps avoidance gait. The peak external flexion torque (resisted by the knee extensor muscles) placed on the injured knee was significantly less than that of the uninjured knee when ascending stairs (at 12 months, 68.4 and 85.3 N-m in the injured and uninjured knees, respectively) and also when descending stairs (at 12 months, 70.8 and 81.7 N-m in the injured and uninjured knees, respectively). The injured knee produced significantly less power than the uninjured knee when ascending stairs, but this difference was not significant when descending stairs. These findings indicate that asymmetric gait patterns persisted up to 1 year after surgical reconstruction and were more pronounced during stair ascent and descent than in level walking. These results indicate that clinicians should include specific interventions targeted at improving knee function during stair use to restore normal function after anterior cruciate ligament reconstruction.     

带线锚钉治疗膝内侧副韧带止点撕脱损伤

目的 探讨利用带线锚钉治疗膝关节内侧副韧带止点撕脱伤的临床疗效。方法使用TwinFix带线锚钉治疗膝关节内侧副韧带止点撕脱伤35例,随访观察治疗前后的症状、体征并进行评分。结果所有患者均获随访,时间13～35个月,平均16．5个月。术后关节功能明显改善。根据Lysholm膝关节评分标准评定膝关节功能,术前评分为（54．5±6．3）分,术后1年评分（88．1±4．2）分,比较术前与术后有显著性差异（P〈0．05）。结论利用带线锚钉治疗膝关节内侧副韧带止点撕脱伤疗效肯定,具有操作简便、固定牢靠、并发症少等优点。     

膝关节多发韧带损伤重建术后异位骨化的57例临床观察

目的 探讨膝关节多发韧带损伤术后异位骨化(HO)的发生率及其相关因素.方法 选取2006年1月至2009年6月连续收治且获得随访的57例多发韧带损伤患者,男39例,女18例;左侧27例,右侧30例;平均年龄29.3岁(17 ～44岁).回顾性分析患者的病史、致伤原因、损伤程度及手术方法等.记录HO的发生情况及部位,使用象限分度法将HO分为5度,并将患者分为骨化组与非骨化组进行比较研究.结果 57例患者术后获平均28.4个月(12 ～51个月)随访.21例(36.8％)患者发生HO,其中1度7例(33.3％),2度9例(42.9％),3度5例(23.8％).骨化组与非骨化组患者的性别、年龄、致伤原因、损伤程度、受伤至手术时间及后交叉韧带手术方式差异均无统计学意义(P＞0.05).HO单独发生在内上象限者13例(61.9％),涉及内上象限者5例(23.8％),仅有3例(14.3％)单独发生在内下或后下象限.非骨化组与骨化组患者膝关节屈膝活动度平均分别为132.5°±5.0°、124.0°±13.0°,损伤严重程度评分平均分别为(9.1±2.1)、(13.3±8.4)分,使用麻醉下推拿的例数分别为l、7例,差异均有统计学意义(P＜0.05).结论 HO是膝关节多发韧带损伤的较常见并发症.损伤严重程度评分是HO发生的影响因素,且发生HO的患者会导致膝关节屈膝角度受限.     

Surgical treatment of knee joint ligaments]

Because injuries of the ligaments of the knee joint, during 11 years 58 operations have been performed by the authors. In order to evaluate the late results, all patients have been reexamined 1 to 10 years after the operation. In more than the half of the cases at the least 2 ligament injuries have been operated on. 31 patients underwent the operation within two weeks after the injury, and the other patients later on. The authors' material and results are compared also with the data of the literature. In the authors' opinion the result of the surgical treatment is not decisively depending on the chosen operative method. The early and exact diagnosis--forming the basis of the suitable treatment--are of far greater importance. The perfect operative technique and the consequent rehabilitation are indispensable requirements of all surgical interventions. After severe ligament injury of the knee joint the surgical intervention allowed to 2/3 or 3/4 of the injured patients to return to work with stabilized knee. In younger patients also sporting may be possible. Therefore the surgical treatment of the knees, which became unstable because of ligament injury, is absolutely indicated in patients in working age.     

带线锚钉治疗膝关节内侧副韧带止点Ⅲ度损伤

目的探讨利用带线锚钉治疗膝关节内侧副韧带止点Ⅲ度损伤的临床疗效。方法使用TwinFix带线锚钉治疗膝关节内侧副韧带止点Ⅲ度损伤24例,随访观察治疗前后的症状、体征并进行评分。结果所有患者均获得随访,随访时间11.0-18.0个月,平均14.2个月。根据Lysholm膝关节评分标准评定膝关节功能,术后关节功能明显改善,手术前后Lysholm膝关节评分差异有统计学意义（P〈0.01）。结论利用带线锚钉治疗膝关节内侧副韧带止点Ⅲ度损伤操作简便,固定可靠,并发症少,疗效肯定。     

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。     

Posterior cruciate ligament replacement with a two-strand quadriceps tendon-patellar bone autograft and a tibial inlay technique

BACKGROUND: Complete ruptures of the posterior cruciate ligament alter knee kinematics and may result in functional limitations with sports and daily activities. We prospectively evaluated the functional results and knee stability after posterior cruciate ligament replacement with use of a two-strand quadriceps tendon-patellar bone autograft and a tibial inlay technique. METHODS: Nineteen patients were followed for a mean of thirty-five months postoperatively. All had a chronic knee injury, and eight had additional ligament reconstructions. The results were measured with stress radiography, arthrometric testing, and two validated knee-rating instruments. RESULTS: Eighteen patients rated the knee condition as improved. Before surgery, eleven patients had pain with daily activities, but only one had such pain at the time of the latest follow-up. Significant improvements were noted for pain, swelling, giving-way, walking, climbing stairs, squatting, running, jumping, and twisting and turning (all p < or = 0.05). Eleven patients returned to low-impact sports, and two patients were able to participate in strenuous sports without problems. At the time of the latest follow-up, stress radiography revealed that fourteen knees had < or =5 mm of increased posterior tibial translation between the reconstructed and the contralateral side, three knees had 6 to 10 mm, and two knees had >10 mm. No knee had an infection, permanent limitation of knee motion, or patellar fracture. CONCLUSIONS: Posterior cruciate ligament replacement produced reasonable subjective, functional, and objective results in this group of complex, chronic knee injuries. The tibial inlay approach was useful in nine revisions in which prior tibial tunnels had to be avoided.