膝关节多发韧带损伤一期修复与重建

目的：探讨膝关节多发韧带损伤关节镜下重建前交叉韧带（anteriorcruciateligament，ACL）和后交叉韧带（posteriorcruciateligament，PCL），及同期修复内副韧带（medialcollateralligament，MCL）、后外侧复合体（posteriorlateralcomplex，PLC）的手术方法及临床疗效。方法：2009年6月。2011年12月，30例病人（31膝）膝关节多发韧带损伤患者采用自体或同种异体肌腱关节镜下重建ACL和PCL，铆钉缝合修复内侧副韧带，铆钉缝合修复或部分股二头肌腱修复后外侧复合体，术后早期功能锻练。根据国际膝关节文献委员会（InternationalKneeDocumentationCommittee，IKDC）评分和Lysholm膝关节功能评分表对患膝功能进行评估。结果：30例病人（31膝）例随访18—30个月，平均24个月。患者在0和200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）18例（58．0％），接近正常（B级）10例（32．3％，），异常（C级）3例（9．7％）。Lysholm评分由术前平均（48．7±4．5）分提高到（87．6±2．6）分，差异有统计学意义（t=-8．432，P〈0．01）。所有患者膝关节功能较术前明显改善。结论：关节镜下一期重建ACL、PCL，同期行关节外韧带修补或重建具有损伤小，能早期功能锻炼，能有效恢复关节功能，治疗效果满意。

One stage repair and reconstruction of multiple ligaments injury of knees joint

Objective： To investigate the clinical effect of anterior and posterior cruciate ligament recon- struction, medial collateral ligament and posterolateral complex simultaneous repair under arthroscope for treatment of multiple ligaments injury of knees joint. Methods： From June 2009 to December 2011, 30 pa- tients （31 knees） with multiple ligaments injury of knees joint underwent ACL and PCL reconstruction with autologous or allogeneic tendon under arthroscope. The medial collateral ligament was repaired with rivet su- ture, and posterolateral complex was repaired with rivet suture or partial biceps femoris tendon. The knee function was evaluated according to the International Knee Documentation Committee （IKDC） score and Lysholm score. Results： 30 patients were followed up for 18-30 months （mean 24 months）. The stability were fully recovered in 0 and 20~stress testing, IKDC scores on admission was significantly abnormal （grade D）, and improved to normal （Grade A） in 18 cases （58%）, close to normal （grade B） in 10 cases （32.3%,）, abnormal （grade C） in 3 cases （9.7%） at the postoperative follow-up visit. The Lysholm score was increased from （48.7＋4.5） to （87.6~2.6）, the difference was statistically significant （t=8.432, P〈0.O1）. The knee joint function was significantly improved in all patients after operation. Conclusion： Reconstruction of ACL and PCL under arthroscope, together with joint outer ligaments repair or reconstruction not only can obtain a minimal trauma and a satisfactory therapeutic efficacy but also can get an effective joint functional recovery.