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。

One-stage repair and reconstruction of knee anterior cruciate ligament, posterior cruciate ligament, and medial collateral ligament

Objective To investigate the e ectiveness of anterior cruciate ligament(ACL) and posterior cruciate ligament(PCL) reconstruction combined with limited open repair of medial collateral ligament(MCL) in recovering the stability and the function of the knee.Methods Between April 2003 and October 2010,14 patients(14 knees) with multiple injuries of ACL,PCL,and MCL were treated.There were 10 males and 4 females with an average age of 41 years(range,2171 years).Injury was caused by tra c accident in 11 cases and falling in 3 cases.The average time from injury to admission was 2 days(range,1-4 days).Lysholm score was 17.00 ± 8.29,and the International Knee Documentation Committee(IKDC) score was 20.93 ± 8.28.The complicated injuries included dislocation of the knee joint in 9 cases and meniscus injury in 5 cases.Allogeneic tendons(2 cases) and autologous harmstring tendon(12 cases) were used to reconstruct ACL and PCL under arthroscopy,and all cases underwent limited open repair of MCL.Results All incisions healed by rst intention.Numbness of the lower limb occurred in 3 cases and alleviated spontaneously.All patients were followed up 14 months on average(range,12-18 months).The knee exion was 120° and extension was 0° at 3 months of follow-up.After 1 year of follow-up,IKDC score and Lysholm score were 89.93 ± 6.26 and 88.93 ± 4.82,respectively,showing signi cant di erences when compared with preoperative scores(P < 0.01).Conclusion For multiple injuries of the knee ligaments,an arthroscope with limited open repair and reconstruction of the knee ligament can avoid open joint chamber,reduce postoperative articular adhesion,and encourage the joint function recovery.