膝关节后内侧结构损伤合并单一交叉韧带断裂的早期治疗

目的 探讨膝关节后内侧结构损伤合并单一交叉韧带断裂进行早期手术的疗效.方法 2002年1月至2005年12月共治疗12例后内侧结构损伤合并单一交叉韧带断裂患者,其中10例合并前交叉韧带(ACL)断裂,2例合并后交叉韧带(PCL)断裂.交叉韧带损伤术前Lysholm评分为50～60分(平均56.7分).关节镜下重建交叉韧带,开放修复后内侧结构.8例采用自体半腱肌、股薄重建ACL(transfix术式),2例采用骨.髌腱.骨重建ACL.2例采用一端带骨块的异体跟腱蓖建PCL.后内侧结构损伤修复:8例采用星状钢板螺钉同定,2例采用GⅡ锚钉固定.1例采用自体半肌腱、股薄肌移植重建,1 例采用端对端缝合.结果 12例中除2例随访4个月后失访外,其余10例患者术后获平均12个月(6～18个月)随访.交叉韧带损伤重建后Lysholm评分为74～94分(平均81.2分).后内侧结构修复后10例膝伸屈范围正常,2例伸直受限5.外翻应力试验于O啦时,9例正常,2例弱阳性(+),1例阳性(++).结论 膝后内侧结构损伤合并单一交叉韧带断裂时,早期重建交叉韧带同时一期修复膝后内侧结构可以较好地恢复膝关节稳定性.

Surgical treatment of injury to posteromedial knee structure complicated with rupture of single cruciate ligament

Objective To discuss clinical outcomes of surgical treatment of injury to the postero-medial knee structure complicated with rupture of anterior cruciate ligament(ACL)or posterior cruciate ligament(PCL).Methods Twelve cases of complex injury to posteromedial knee structure were treated from January 2002 to December 2005.Ten were complicated with ACL rupture and 2 with PCL rupture.The ruptured ACL or PCL was reconstructed by arthroscopy and the injured posteromedial structure was repaired by open approach.Autologous semitendinosus and gracilis were used for 8 ACL reconstruction and bone-patellar tendon-bone(B-T-B)technique for the other 2 ACL reconstructions.The ruptured PCL was reconstructed with allograft of achillis tendon.In repairing the injured posteromedial structure, 8 cases used star-shaped steel plates, 2 G 鈪?anchor screws, 1 autologous graft of semitendinosus and gracilis, and 1 end-to-end suture.Results All the cases were followed up for 12(6 to 18)months on average except the two who had a follow-up of only 4 months.The mean functional score of the knee improved from 56.7(50 to 60)preoperatively to 81.2(74 to 94)postoperatively by Lysholm system.Ten cases recovered normal range of knee flexion and extension after cruciate ligament reconstruction while 2 had a restricted extension of 5 degrees.Nine cases obtained an excellent result in lateral stress test at angle zero, 2 "+" and 1"+ +".Conclusion Early reconstruction of cruciate ligament during repair of the posteromedial structure can result in excellent knee stability for the injury to the posteromedial knee structure complicated with rupture of single cruciate ligament.