膝关节后交叉韧带合并后外侧角结构损伤的联合重建

Combined reconstruction of the injured posterior cruciate ligament and posterolateral complex of the knee

目的探讨膝关节后交叉韧带（PCL）合并后外侧角结构（PLC）实质部损伤时进行联合重建的必要性，介绍使用关节镜下5-6股胭绳肌腱单束重建膝PCL以及采用中1／3股二头肌腱、股薄肌重建PLC的技术和优点。方法自2001年1月至2006年12月，收治膝关节PCL合并PLC损伤患者28例，均为PCL损伤≥Ⅱ°b、PLC损伤〉Ⅱ°。X线片有韧带附着点撕脱骨折及严重内翻不稳需要胫骨截骨者不计人本组。治疗方法：手术治疗28例，其中2002年1月至2003年12月间8例行关节镜下胭绳肌腱单束重建PCL，而PLC保守治疗；2002年1月至2006年12月间20例关节镜下修复重建PCL，再开放手术操作修复重建PLC结构。结果随访6-24个月，平均15个月。功能评定按照Lysholm标准，单纯修复PCL组中等3例，差5例；PCL和PLC联合重建者中优良19例，中等1例。两组的Lysholm评分平均为（47．1±8．2）分和（86．7±7．2）分，差异有统计学意义（t=19．277，P〈0．05）；IKDC评估两组分别有3例和19例对手术结果满意。无严重并发症发生。结论膝关节PCL合并PLC损伤可造成患肢严重的无法代偿的功能损害，手术时应当进行联合重建，忽视PLC重建的重要性，会导致PCL重建效果下降或失败；采用关节镜下5-6股胭绳肌腱单束重建膝PCL以及采用中1／3股二头肌腱、股薄肌重建PLC的技术治疗PCL合并PLC损伤取得较好的临床效果。

Objective To discuss the necessity and methods of combined reconstruction of the injured posterior cruciate ligament （PCL） and posterolateral complex （PLC） of the knee. Methods From January 2001 to December 2006, 28 patients with injury of both PCL （≥ Ⅱ°b） and PLC （〉 Ⅱ°） of the knee were treated operatively in our department. Eight patients received arthroscopic PCL reconstruction with single bundle of 5-6 strands of hamstring and conservative treatment of PLC during January 2001 to December 2003. Twenty patients received arthroscopic PCL reconstruction followed by open operative repair of PLC with median 1/3 femoral biceps tendon and gracilis during January 2002 to December 2006. Results All the patients were followed up for 6 to 24 months postoperatively （mean, 15 months） . By Lysholm scoring, 3 cases obtained good results and 5 poor in the first group, while 19 excellent and 1 good in the second group. The mean Lysholm scores were 47.1±8.2 and 86.7±7.2 respectively （P 〈0.05） . According to IKDC scale, 3 patients （37.5%） in the first group and 19 patients （95.0%） in the second group were graded normal or nearly normal （t=19.277,P〈0.05）. Conclusion Arthroscopic PCL reconstruction with single bundie of 5-6 strands of hamstring plus PLC reconstruction with 1/3 femoral biceps tendon and gracilis is more reliable to restore the stability of the knee than PCL reconstruction only.