创伤性膝关节脱位失稳性的检查与治疗

Examination and surgical treatment of lost instability of traumatic dislocation of the knee joint

目的:探讨创伤性膝关节脱位失稳性的检查方法、手术时机与治疗方法。方法:本组63例创伤性膝关节脱位,男48例,女15例;年龄16～75岁,平均36.6岁。鲜新膝关节脱位40例,陈旧膝关节脱位23例。按Wascher膝关节脱位分型标准:KD-Ⅰ型1例,KD-Ⅱ型13例,KD-Ⅲ型17例,KD-Ⅳ型18例,KD-Ⅴ型14例。结合物理与影像学检查评判患膝稳定性。单纯开放手术治疗53例,单纯关节镜治疗4例,关节镜加开放手术治疗4例,截肢1例,全膝关节置换1例。结果:膝MRI阳性率100%(39/39),膝应力位X线检查阳性率100%(19/19),膝关节镜阳性率93.3%(14/15)。按Lysholm膝关节评分标准:治疗前陈旧伤组平均(37.17±5.33)分,新鲜伤组平均(37.41±5.38)分;治疗后陈旧伤组平均(67.33±14.72)分,新鲜伤组平均(82.45±12.13)分(Z=-3.061,P=0.002)。结论:膝关节应力位X线检查、MR及关节镜检查对评判创伤性膝关节脱位的稳定性有积极意义,失稳性创伤膝关节脱位手术治疗的关键是早期,鲜新伤以修复为主,陈旧伤以重建为主。

Objective ：To study the examination ,surgical opportunity and surgery methods of lost instability of traumatic dislocation of the knee joint. Methods：Sixty-three patients （48 males and 15 females, ranging in age from 16 to 75 years, with an average of 36.6 years）were checked ,treated and followed up from January 2001 to April 2006. According to classification of Wascher for knee dislocation, there was 1 case of KD- Ⅰ , 13 KD- Ⅱ , 17 KD-Ⅲ, 18 KD-Ⅳ, 14 KD-Ⅴ. Stability of the knee was evaluated by physical and radiological examinations, of which 53 patients were treated with open surgery, 4 patients were treated with arthroscope ,4 patients were treated with arthroscope and open surgery, 1 patient was treated with amputation, 1 patient was treated with total knee arthroplasty. Results：The detection rate of MRI was 100% （39/39）,stress radiography was 100% （19/19） ,arthroscpoe was 93.3% （14/15）. According to Lysholm Criteria for knee joint function,the preoperative Lysholm score in old traumatic group was 37.17±5.33 ,fresh traumatic group was 37.41 ±5.38. The postoperative Lysholm score in old traumatic group was 67.33±14.72, fresh traumatic group was 82.45±12.13 （Z=-3.061 ,P=-0.002）. Conclusion： MRI stress radiography and arthroscope do well for the evaluation of stability of the knee. Instable traumatic dislocation of the knee joint must be operated promptly. Fresh instable dislocations of knee prefer repair, old instable dislocations of knee prefer recon- struction.