驾驶摩托车致膝关节前内侧旋转不稳定的手术治疗

目的探讨手术治疗驾驶摩托车致膝关节前内侧旋转不稳定(antero-medial rotatory instability,AMRI)的效果。方法 2007年6月-2009年12月,收治32例驾驶摩托车致膝关节AMRI患者。男28例,女4例;年龄20～50岁,平均35.5岁。受伤至手术时间5～10 d,平均7 d。前交叉韧带(anterior cruciate ligament,ACL)均于胫骨髁间嵴附着点处撕脱;内侧副韧带(medial collateral ligament,MCL)损伤部位:中央部位19例,股骨内侧髁部10例,胫骨内侧髁部3例。均为闭合损伤。采用钢丝固定胫骨髁间嵴撕脱骨折块,同时修复MCL治疗。结果术后1例发生切口红肿伴少量渗液,其余患者切口均Ⅰ期愈合。5例发生膝关节创伤性关节炎,经相应处理后好转。术后患者均获随访,随访时间16～22个月,平均18.5个月。X线片检查示胫骨髁间嵴骨折均于术后5～8周愈合,平均6周。末次随访时,患者膝关节伸膝均达0°;屈膝110～170°,平均155°。采用国际膝关节文献委员会(IKDC)分级标准评价膝关节功能,获A级24例,B级6例,C级1例,D级1例。Lysholm膝关节评分为(85.93±3.76)分,明显高于术前的(37.54±3.43)分,差异有统计学意义(t=53.785,P=0.000)。结论驾驶摩托车致膝关节AMRI,采用钢丝固定胫骨髁间嵴撕脱骨折块,同时修复MCL治疗,结合术后早期功能锻炼,近期疗效满意,远期疗效尚需随访观察。

SURGICAL TREATMENT OF ANTERO-MEDIAL ROTATORY INSTABILITY OF KNEE JOINT CAUSED BY MOTORCYCLE

Objective To discuss the effectiveness of operation technique for antero-medial rotatory instability (AMRI) of the knee joint caused by motorcycle. Methods Between June 2007 and December 2009, 32 cases of AMRI caused by motorcycle were treated. There were 28 males and 4 females with an average age of 35.5 years (range, 20-50 years). The interval between injury and surgery was 5-10 days (mean, 7 days). The anterior cruciate ligament (ACL) was injured at the attachment point of the condyles crest; the medial collateral ligament (MCL) was injured at central site in 19 cases, at medial condyles of femur in 10 cases, and at medial condyles of tibia in 3 cases, which were all closed injuries. The bone avulsion of condyles crest was fixed by steel wire and MCL was repaired. Results Red swelling and a little effusion occurred at the incision in 1 case, and the other incisions healed by first intention. Traumatic arthritis of the knee occured in 5 cases. Thirty-two cases were followed up 16-22 months (mean, 18.5 months). The X-ray examination showed that the fracture union time was 5-8 weeks (mean, 6 weeks) after operation. At last follow-up, the extension of knee joint was 0° and the flexion of the knee joint was 110-170° (mean, 155°). According to the synthetic evaluating standard of International Knee Documentation Committee, 24 cases were rated as A level, 6 cases as B, 1 case as C, and 1 case as D at last follow-up. Lysholm knee score was 85.93 ± 3.76 at last follow-up, which was significantly higher (t=53.785, P=0.000) than preoperative score 37.54 ± 3.43. Conclusion In patients with AMRI caused by motorcycle, steel wire is used to fix the bone avulsion of condyles crest and MCL should be repaired simultaneously as far as possible. And associating with the early postoperative functional exercise, the short-term effectiveness is satisfactory, but long-term effectiveness still need further follow-up observation.