膝关节后内侧结构损伤早期修复疗效观察

Early surgical treatment for injury of posteromedial structure of the knee

[目的]探讨膝关节后内侧结构损伤(内侧副韧带MCL,后斜韧带POL)的手术治疗效果。[方法]2002年1月～2007年10月共治疗14例后内侧结构损伤中12例合并ACL断裂,2例合并PCL断裂。后内侧结构损伤分型:Ⅰ型:8例,后内侧结构于股骨止点撕裂,带小片骨块,0.8～1.0cm。Ⅱ型:2例,后内侧结构于股骨止点撕裂,无骨块。Ⅲ型:2例,后内侧结构于体部断裂。Ⅳ型2例,后内侧结构于胫骨止点撕裂。后内侧结构损伤修复:8例采用星状钢板螺钉,4例采用GⅡ锚钉(2例固定于股骨内上髁,2例固定于胫骨内侧止点)。关节镜下交叉韧带重建:8例ACL断裂采用自体半腱肌、股薄肌重建ACL(tranfix)术式,2例ACL断裂采用骨-髌腱-骨术式,2例ACL于胫骨止点撕脱关节镜下复位空心钉固定,2例PCL断裂采用一端带骨块异体跟腱重建PCL。[结果]本组14例中2例随访4个月后失访,平均随访12个月(6～18个月),交叉韧带损伤重建后评分(Lysholm)74～94分(平均81.2分),术前50～60分(平均56.7分)。后内侧结构修复后10例膝伸屈范围正常,2例伸直受限5°。外翻应力试验于0°位,9例正常,2例+,1例++。[结论]膝后内侧结构损伤积极外科治疗可以收到较好的手术效果,恢复膝关节内后侧稳定性。

[ Objective] To discuss the postoperative effect of the posteromedial structure injury （medial collateral ligament, MCL,posterior oblique ligament, POL） of the knee. [ Method ] Fourteen cases of complex posteromedial structure injury were treated from January 2002 to October 2007 ,twelve of which combined with ACL injury and two combined with PCL injury. Classification of posteromedial structure injury：type Ⅰ ,8 cases, ruptured from the femur with small bone fragment;type Ⅱ ,2 cases, ruptured from the femur without bone fragment;type Ⅲ ,2 cases, the structure were torn from the body area, and type Ⅳ,2 cases, ruptured from the tibia. The injury were repaired by different techniques according to the classification. Eight cases applied starshaped steel plate, four with G Ⅱ anchor screws （2 attached to the femur and 2 to the tibia adhesion respectively）, and 2 cases with end-to-end suture. The ruptured ACL and PCL were reconstructed by arthroscopy. Autologous semitendinosus and gracilis were used for 8 ACL reconstruction and B-T-B technique for the other two ACL reconstruction. Two ruptured PCL were reconstructed with allograft of Achilles tendon. [ Result] All cases were followed up for twelve months at average（6-18 months） except two cases only for four months. The functional score of the knees were improved from 56.7 （ 50 - 60 ） preoperatively to 81.2 （ 74 - 94） postoperatively in average valued by Lysholm system. Ten cases received normal knee flexion and extension range after repair of the posteromedial structure while 2 cases with restricted 5 degree extension. Nine cases received excellent result in lateral stress test while 2 cases with ＂ ＋ ＂ and 1 case with ＂ ＋ ＋ ＂ at zero angle. [ Conclusion] Early repaire for the posteromedial structure injury will deliver excellent knee stability.