膝关节多发韧带损伤的修复与重建

Arthroscopic reconstruction of multiple ligaments injury of knees

目的 探讨关节镜下重建膝关节前十字韧带（anterior cruciate ligament,ACL）、后十字韧带（posterior cruciate ligament,PCL）、后内侧韧带结构（posteromedial complex,PMC）或后外侧韧带结构（posterolateral complex,PLC）损伤的疗效.方法 2005年3月至2007年5月,43例膝关节多发韧带损伤患者采用异体肌腱于关节镜下重建ACL和PCL,同期重建增强PMC或PLC损伤.其中24例行ACL和PCL重建＋PMC重建,19例行ACL和PCL重建＋PLC重建.根据国际膝关节文献委员会（International Knee Documentation Committee,IKDC）评分和Lysholm膝关节功能评分表对患膝功能进行评估.结果 全部患者随访24～48个月,平均（33.10±9.65）个月.患者在0°和20°应力测试时稳定性均完全恢复.IKDC评分入院时均为显著异常（D级）,术后随访时正常（A级）29例（67%,29/43）、接近正常（B级）11例（26%,11/43）、异常（C级）3例（7%,3/43）.患者术前Lysholm膝关节功能评分为（46.7±4.2）分,末次随访时为（89.6±2.8）分,差异有统计学意义（t=8.563,P＜0.01）.结论 膝关节多发韧带损伤可于关节镜下行ACL和PCL联合重建,同期行关节外韧带结构修复增强,能有效恢复关节功能,治疗效果满意.

Objective To describe the surgical technique and outcomes of arthroscopic reconstruction anterior cruciate ligament （ACL） and posterior cruciate ligament （PCL） and repair of the injured posteromedial complex （PMC） or posterolateral complex （PLC） structures of the knee joint in treatment of multiple ligaments injuries of knee. Methods From March 2005 to May 2007, 43 patients with multiple ligaments injuries of knee underwent arthroscopic reconstruction. Twenty-four patients were treated with arthroscopic reconstruction of combined ACL and PCL with allograft tendons and augmentation of PMC. The other 19 patients were treated with repair the PLC in addition to reconstruction of ACL and PCL. The International Knee Documentation Committee （IKDC） and Lysholm knee score were used for function evaluation. Results All patients were followed up for 24 to 48 months with an average of 33.10±9.65 months. The stability recovered when stress was applied to the knee at 0° and 20° of flexion. According to IKDC there was a significant improvement from severely abnormal （graded D） in 43 cases before surgery to normal （graded A） in 29 cases （67%）, nearly normal （graded B） 11 cases （26%） and abnormal （graded C） 3 cases （7%） at follow-up. The average Lysholm score of the all cases were 46.7±4.2 and 89.6±2.8 before operation and at final follow-up, respectively （t=8.563, P＜0.01）. Conclusion Excellence clinical results and good stability were achieved with arthrescopic reconstruction of ACL and PCL combined with repair or augmentation of the PMC and PLC simultaneously.