膝关节多韧带损伤的临床研究

目的探讨膝关节多韧带损伤的诊断与治疗方法并评价其治疗效果。方法治疗51例单侧膝关节多韧带损伤,其损伤类型：21例前交叉韧带（ACL）＋内侧副韧带（MCL）,1例ACL＋后外侧复合体（PLC）,4例后交叉韧带（PCL）＋MCL,6例PCL＋PLC,6例ACL＋PCL＋MCL,3例ACL＋PCL＋PLC,8例ACL＋PCL,2例PCL＋髌腱。14例急性Ⅲ度MCL和3例急性Ⅲ度PLC损伤行切开手术,原位缝合,外固定制动3周,再行关节镜下其他韧带手术。2例Ⅲ度慢性MCL和3例Ⅲ度慢性PLC损伤行切开韧带重建术,并同期行关节镜下ACL或PCL重建术。在总共39条ACL损伤中,20条行关节镜下自体Hamstring腱ACL重建术,17条行关节镜下自体骨-髌腱-骨（BPB）重建ACL术,2条行同种异体肌腱重建ACL;在总共29条PCL损伤中,19条行关节镜下自体Hamstring腱PCL重建术,2条行同种异体肌腱重建PCL,另8条急性损伤经固定后由Ⅲ度变为〈Ⅱ度损伤,故未特别治疗。其中,17例ACL＋PCL损伤处理方法为：4例先行PCL重建,二期再行ACL的重建,7例同期自体Hamstring腱重建PCL、自体BPB重建ACL,2例为同种异体肌腱同期重建ACL和PCL,4例仅做ACL重建术。1例髌腱完全性断裂原位修复,另1例部分性髌腱损伤者未治疗。4例合并腓总神经损伤均未做特别治疗。结果平均随访2.4年（9个月～5年）。术后Lysholm评分平均为86.3（51～100）,Tegner活动评分为5.2（2～8）,均较术前显著增加（P〈0.001）。1例外翻试验为2＋,2例Lachman试验或轴移试验≥2＋,6例应力后沉征或后抽屉试验2＋,4例内翻试验或反轴移试验2＋。其余的对应各种体格检查均为≤1＋。4例合并腓总神经损伤者,术后3例自行恢复,1例未恢复。结论在多韧带损伤中,≤Ⅱ度的MCL或者PLC损伤应采用保守治疗,Ⅲ度损伤者应尽早手术原位修复内侧副韧带及其关节囊或PLC,以利于后期进行其他重要韧带的治疗。交叉韧带或关节内重要组织可二期在?

Treatments for Multiple-Ligament Injury to the Knee

Objective To study the diagnosis and treatment of multiple-ligament injury to the knee and report the clinical outcomes of the disease.Methods A total of 51 patients with multiple-ligament tear in the knee were enrolled in this study.The lesion involved the ACL and MCL in 21 cases,ACL and PLC in 1,PCL and MCL in 4,PCL and PLC in 6,ACL,PCL,and MCL in 6,ACL,PCL,and PLC in 3,ACL and PCL in 8,and PCL and patella tendon in 2.Among the patients,14 patients had acute Ⅲ grade MCL tear and 3 had acute Ⅲ grade PLC injury;open suture repair were performed on these cases,and then arthroscopic surgery was carried out for other injured ligaments after 3-week immobilization.For 2 patients who had chronic Ⅲ grade MCL injury and 3 cases that were suffering from chronic Ⅲ grade PLC tear,open surgery for ligament reconstruction was employed,arthroscopy were used afterwards to remodel the ACL and PCL.In the 51 patients,totally 39 ACLs were injured,20 of these ligaments were reconstructed under a arthroscope using Hamstring tendon,17 were repaired with BPB by arthroscopy,and 2 were remodelled by implanting allogeneic tendons.In addition,29 PCLs tear were diagnosed,among which arthroscopic PCL reconstruction with autologous Hamstring tendon was performed on 19,allogeneic ligaments were used in 2,and the other 8 injured PCL were not repaied surgically because the lesion was relieved after immobilization（improved from grade Ⅲ to 〈 grade Ⅱ ）. In our cases, 17 were injued on both the ACL and PCL. For these patients, we carried out PCL reconstruction and second-stage remodelling of the ACL in 4; empolyed autologous Hamstring tendon and BPB to reconstruct the PCL and ACL in 7; used homograft tendons for first-stage operation in 2; and performed only ACL reconstruction on 4. Of the 2 injured patella tendons, one had been completely torn and was repaired buy surgery, the other was partialy injured and was treated conservatively. Common peroneal nerve injury was found in 4 cases in this group, but no treatment was employed f