膝内侧副韧带松弛合并陈旧性前交叉韧带损伤的手术治疗

目的 探讨应用自体骨-髌腱-骨重建受损的前交叉韧带(ACL),同时半腱肌腱转位联合内侧副韧带股骨止点上移治疗内侧副韧带松弛的临床疗效.方法 采用自体骨-髌腱-骨重建受损的ACL,同时半腱肌腱转位联合内侧副韧带股骨止点上移的方法治疗内侧副韧带松弛20例,其中男14例,女6例,年龄16～64岁,平均年龄32.6岁.术前X线评估Ⅱ度1例,Ⅲ度19例,MRI评估均为3度损伤,术前Lysholm膝关节评估法评分35～65分(平均48.9分).结果 术后20例全部获得随访;随访时间6～59个月,平均19.2个月.术后Lysholm评分50～96分,平均83.9分,优良率90%.术后1例关节屈曲90°,1例关节疼痛加重,其余膝关节功能均正常.结论 自体骨-髌腱-骨重建及半腱肌腱转位联合MCL股骨止点上移是一种可靠的治疗膝内侧副韧带松弛合ACL损伤的手术方法.

Surgical treatment of medial collateral ligament laxity complicated by old cruciate ligament injury of the knee

OBJECTIVE: To investigate the therapeutic effect of transposition of semitendinosus tendon combined with femur insertion of medial collateral ligament (MCL) and reconstruction of anterior cruciate ligament (ACL) with autograft bone-patellar tendon-bone in treatment of MCL laxity complicated by ACL injury of the knee. METHODS: Twenty patients (20 knees), 14 male and 6 female, aged 32.6 (16-64), 1 case at grade II and 19 cases at grade III according to X ray classification, all cases at grade III by MRI evaluation, and with preoperative Lysholm knee joint score of 48.9 (35-65), underwent transposition of semitendinosus tendon combined with femur insertion of medial collateral ligament (MCL) and reconstruction of anterior cruciate ligament (ACL) with autograft bone-patellar tendon-bone. Followed up was conducted for 19.2 (6-59) months. RESULTS: The postoperative Lysholm score was 83.9 (50-96). Eighteen of the 20 patients obtained an excellent result with good function of the knee joint except one case with osteoarthritis and one case with limited range of motion of the knee (90 degree), and the good-to-excellent rate was 90%. CONCLUSION: Reconstruction with autograft of the bone-patellar tendon-bone and transposition of semitendinosus tendon combined with femur insertion of MCL proximal transfer is a reliable treatment method for MCL laxity complicated by old ACL injury of the knee.