局部修复和（或）异体肌腱重建治疗急性膝关节后外侧复合结构损伤

Local suture repair and（or） aHograft tendon reconstruction for acute posterolateral complex injuries of the knee joint

目的探讨采用局部修复和（或）异体肌腱重建治疗急性膝关节后外侧复合结构（postero—latera lcomplex，PLC）损伤的方法及疗效。方法2006年5月至2008年10月，收治急性PLC损伤患者12例，男9例，女3例；年龄23～47岁，平均31岁；合并后十字韧带损伤9例，合并前、后十字韧带同时损伤3例。首先在关节镜下采用异体肌腱解剖重建前、后十字韧带，然后对于PLC两端附着点撕脱损伤的患者采用铆钉固定、缝线缝合修复治疗；对于PLC实质部断裂的患者采用局部缝合修复和（或）异体肌腱重建的方法治疗。术后根据KT-1000、IKDC及Lysholm功能评定标准评价膝关节功能恢复情况。结果12例患者均获得随访，随访时间12-18个月，平均1313个月。膝关节活动度由术前118．00°±6．77°提高至术后130．75°±3．05°。KT-1000由术前（14．85±1．83）mlTl改善至术后（4．18±1．88）mm。根据IKDC综合评定标准，A级7例，B级3例，C级1例，D级1例。Lysholm膝关节功能评分由术前35-44分[平均（38．83±3．16）分]提高至术后79-91分[平均（84．92±3．73）分]。所有患者患膝均无感染及免疫排斥反应。3例患者住院期间B超显示患侧小腿肌问静脉血栓，经低分子肝素钙治疗后好转。2例患者膝关节屈曲较对侧少15°。结论对于急性PLC损伤患者，PLC两端附着点撕脱损伤采用铆钉固定、缝线缝合修复；实质部断裂的患者采用局部缝合修复和（或）异体肌腱重建治疗可取得较好的效果。

Objective To evaluate the surgical treatment of the acute posterolateral complex （PLC） injuries of knee joint and then observe the clinical outcome. Methods Twelve cases （12 knees） of acute PLC injuries were treated from May 2006 to October 2008. Patients＂ age ranged from 23 to 47 years old, average 31 years. There were 9 males and 3 females. Rebuild the anterior cruciate ligament （ACL） and posterior cruciate ligament （PCL） under arthroscope and then, locally suture the PLC injuries sites on those patients with PLC avulsion fraction. If there is PLC rupture, then locally suture the injury sites plus PLC reconstruction. Knee functions were evaluated by IKDC and Lysholm score. Results All patients were followed up for 12-18 months （mean, 13.3 months）. The preoperative range of motion was 118.00°±6.77°, which was 130.75°± 3.05° after surgery. KT-1000 arthrometer measurement showed that the average posterior translation improved from （14.85±1.83） mm preoperatively to （4.18±1.88） mm postoperatively. Seven cases were normal（A grade）, 3 cases were nearly normal （B grade）, 1 abnormal （C grade）, and 1 severely abnormal（D grade） ac- cording to IKDC standard. The preoperative Lysholm joint function score was 35-44, average 38.83±3.16, which was 79-91, average 84.92±3.73 after surgery. Conclusion To those acute PLC injuries with avulsion at the ligament extremities, locally suture should be taken. But for those with PLC rupture at the mid part of ligament, locally suture the iniurv sites plus PLC reconstruction helps get satisfactory outcome.