全关节镜下膝关节后外复合体重建

Arthroscopy assisted anatomical posterolateral corner reconstruction technique

目的 介绍全关节镜下腘肌腱重建、腘肌腱联合腘腓韧带重建或膝关节后外复合体（posterolateral corner,PLC）解剖重建的手术技术,探讨全关节镜下PLC重建治疗膝关节后外不稳定的效果.方法 2008年8月至2010年4月,共完成全关节镜下后十字韧带（posterior cruciate ligament,PCL）＋PLC重建手术34例.患者在接受手术时平均年龄34.1岁（15～52岁）;男32例,女2例;从受伤到手术平均10.7个月.所有病例均为陈旧性损伤,且均为复合韧带损伤.所有PCL损伤的病例都存在PLC损伤.合并前十字韧带损伤6例（17.6%）,合并前十字韧带、内侧副韧带损伤2例（5.9%）,合并内侧副韧带损伤5例（14.7%）.对膝关节PLC损伤进行分型,采用不同的重建技术进行治疗.对于A型旋转不稳定,采用全关节镜下腘肌腱重建、腘肌腱联合腘腓韧带重建;对于C型后外不稳定,采用全关节镜下PLC解剖重建.结果 14例患者获得随访并进行二次关节镜检查,平均随访18.5个月（13～25个月）.终末随访包括：膝关节查体、KT-1000测量、膝关节应力像和胫骨外旋稳定性.使用膝关节应力像测量胫骨后移程度,胫骨后移由术前平均15.56mm减少为术后5.16mm,手术前后差异有统计学意义.使用屈膝30°位胫骨外旋试验评估膝关节后外旋转不稳定.对比患侧与健侧胫骨外旋的差值,由术前平均14.92°减小为术后-0.22°,手术前后差异有统计学意义.术后患者平均屈曲受限4.23°,无伸膝受限.结论 对于膝关节PLC损伤导致的不稳定,采用全关节镜下PLC重建的手术技术,能够有效恢复膝关节后外旋转不稳定.这种手术技术能够与PCL重建联合应用.

Objectiye To introduce the surgical technique of arthroscopy assisted anatomical posterolateral corner （PLC） reconstruction,including popliteal ligament,popliteofibular ligament and lateral collateral ligament,and evaluate the results of this technique.Methods From August 2008 to April 2010,34arthroscopic posterior cruciate ligament （PCL） and PLC reconstruction surgeries were performed.The average age of the patients was 34.1 （15-52） years.There were 32 males and 2 females.The average time period from injury to surgery was 10.7 months.All patients were chronic injuries and combined ligament injuries,including PCL and PLC injuries.Some cases had other ligament injury,including 6 patients of anterior cruciate ligament （ACL） injury （17.6%）,2 of ACL combined medial cruciate ligament （MCL） injuries （5.9%）,and 5 of MCL injuries （14.7%）.According to Fanellis classification,for type A posterolateral rotation instability,we performed arthroscopic popliteal ligament reconstruction or popliteal ligament combined popliteofibular ligament reconstruction.For type C posterolateral instability,we performed arthroscopic PLC anatomical reconstruction.Results During the follow-up period,14 patients had undergone a second look arthroscopic examination and removal of hardware.The average follow-up time was 18.5 months （13-25 months）.At the final follow-up,physical examination,stability evaluation with KT-1000 and Telos stress view,and dial test were performed.The posterior displacement of the knee had decreased from 15.56 mm preoperatively to 5.16mm postoperatively.The external rotation instability had decreased from 14.92° preoperatively to -0.22°postoperatively.The average limitation of knee flexion was 4.23° and no knee extension was limited.Conclusion With the surgical technique of arthroscopy assisted anatomical PLC reconstruction,we can restore the external rotation stability of knee.This technique can be performed combine with PCL reconstruction.