单纯膝关节内侧副韧带断裂的手术治疗（附30例临床报告）

Surgical Treatment of Simple Medial Collateral Ligament(MCL)Rupture of the Knee

本组单纯膝关节内侧副韧带断裂病人３０例。其中陈旧性断裂５例。受伤机转主要为膝关节屈曲外翻外旋伤。损伤程度均为Ⅲ度，即内侧副韧带浅深层完全断裂，部分病例内侧关节囊同时撕裂。手术方法依韧带断裂部位不同而异。上止点及中间部断裂采用先重叠缝合断裂韧带，同时取股薄肌或半腱肌肌腱加强。下止点断裂修复方法有３种，其中以凿骨隧道方法较好。术后用石膏托将膝关节固定于屈曲３０°位，４周后换用膝关节活动支具继续固定４周（仅允许膝关节在３０°－６０°范围内屈伸活动），同时开始逐步负重行走和进行康复训练。术后８周去除支具。术后３－６个月恢复专项训练有２０例。作者认为：单纯膝关节内侧副韧带断裂应早期手术修复。术后早期妥善固定，后期积极康复训练，对于膝关节功能的恢复至关重要。

Thirty patients who suffered from simple MCL rupture were treated from 1986 to 1989.Most of the patients were athletes.Their average age was 26 years old.The mechanism of the injuries was mainly due to valgus and internal rotation of the knee.All the injuries were grade Ⅲ.The valgus stress test should be performed at 0 and 30 degree flexion of the knee.Different surgical procedures were used according to different rupture type.If the ligament was torn at the distal end of MCL,the best surgical method was to fix the ligament in the bone tunnel of the tibia,The movable splint,which allowed the knee flex 30 to 60 degree,was used after immobilizing for 4 weeks.Twenty-four cases were followed-up for 23 months averagely.The results showed excellent in 22 cases and good in 2 cases.Twenty patients return to special training 3 to 6 months after operation.It was concluded that suitable immobilization and active rehabilitation are very important for the recovery of knee function.