膝关节不稳治疗方法的探讨(附34例报告)

A Study on the Treatment of Knee Instability (A Report of 34 cases)

作者自１９９４年１月～１９９６年１月采用不同的手术方法治疗外伤性膝关节不稳３４例。男性２５例，女性９例，年龄１６～６０岁，平均３２．５岁。其中，单纯内侧副韧带损伤２８例；内侧副韧带＋前交叉韧带伤４例；内侧副韧带＋外侧副韧带伤１例；内侧副韧带＋后交叉韧带伤１例。合并长骨干骨折４例；胫骨平台骨折２例，半月板损伤３例（内侧１例，外侧２例）。新鲜损伤２７例，陈旧损伤７例。内侧副韧带损伤除５例修补，髂胫束和真皮条重建各２例外，其余均行半腱肌肌腱移位重建。前交叉韧带损伤者，２例髂胫束，１例膑腱中１／３，１例真皮条重建。后交叉违带损伤１例真皮条重建。长骨干骨折在处理韧带损伤之前先行坚强内固定，胫骨平台骨折力求解剖复位，并用加压钉或骨栓内固定，并在麻醉下进一步检查确诊韧带损伤类型和程度，半月板损伤者尽可能地予以保留，必须切除者也应尽量保留其周边部位。韧带损伤行延期重建，手术时机以伤后４～８周，平均７～８周为宜，以膝关节疼痛消失或减轻，急性炎症消退，肿胀消失，全范围膝关节活动和肌力恢复正常为指征。以防早期手术后膝关节纤维粘连，僵直和股四头肌肌力削弱的发生。术后经半年～２年平均１年２月随访，疗效满意。

34 cases of traumatic instability of the knee were treated with different operative methods from January 1994 to January 1996. Among them there were 25 males and 9 females and the ages ranged from 16 to 60 with an average of 325 years Injury of isolated medial collateral ligament (MCL) were in 28, MCL and anterior cruciate ligament (ACL) in 4, MCL and lateral collateral ligament (LCL)in 1, MCL and posterior cruciate ligament (PCT) in 1 case. Combined with fracture of long bone was in 4, fracture of tibial plateau in 2, meniscal lesions in 3 knees. MCL were reconstructed with semitendinosus tendon in the most cases except direct repair in 5 and reconstruction with iliotibial band and dermis stripes in 2 respectively. ACL were reconstructed with iliotibial band in 2, central third of patellar ligament in 1, dermis stripe in 1 knee. PCL were reconstructed with dermis stripe in 1 knee. All cases were followedup from 6 months to 2 years, an average of 1 year and 2 months. The results were satisfactory.