微创膝关节镜手术在膝关节后外侧旋转脱位复位诊治中的初步应用

Arthroscopic reduce treat posterolateral dislocation of knee:A primary report

目的观察微创关节镜手术在膝关节后外侧旋转脱位复位诊治中的近期临床效果。方法 2007年9月至2008年8月期间2例2膝急性膝关节后外侧旋转脱位患者,行关节镜手术复位、清创治疗。镜下撬拨、松解卡入髁间窝的内侧关节囊,复位膝关节后1例患者内侧副韧带Ⅲ度损伤行内侧副韧带修补缝合术,1例患者内侧副韧带Ⅱ度损伤,佩戴铰链支具保守治疗。术后患者在铰链支具限制下逐步负重行走锻炼、非负重屈伸功能锻炼和股四头肌肌力训练。随访术后患者疼痛评分、出血量、C反应蛋白(CRP)、膝关节活动度。结果术后患者疼痛迅速缓解,关节腔引流量平均为45mL,术后2周CRP病例1为0.892mg/dl,病例2为1.32mg/dl,术后3个月膝关节活动度分别为病例1:0～90度,病例2为0～130度。结论膝关节镜手术能早期诊断并微创下复位后外侧旋转脱位,彻底的关节清创、术后疼痛轻,康复迅速,避免关节内粘连,具有优良的近期临床疗效。

Objective The purpose of this study is to discuss the clinical effectiveness of arthroscopic reduce in treatment of posterolateral dislocation of knee.Methods The study involved 2 knees in 2 patients from September 2007 to August 2008.Emergency arthroscopy was taken to reduce the knee and debride articular cavity.1 case with medial collateral ligment（MCL）rupture was repaired and another case with MCL partly injury accepted conservative treatment：protected by hinge orthosis to natural healing.The rehabilitation after operation incude progressive weight load limited by immobile splint,knee motion exercise.Fellow up the VAS score,blood after operation,CRP,the range of motion of knee,the follow-up was 3 months.Results All the patients release pain after operation,the mean blood 45ml,CRP case1 0.892mg/dl,case2 1.32mg/dl;ROM of knee 3 months after reduce：case1 0-90° case2 0-130°.Conclusion Arthroscopy reuduce and debride articular cavity,avoid anchylosis result in good outcomes in short term for acute posterolateral dislocation of knee.