同种异体肌腱加强术治疗膝关节后内侧结构陈旧性损伤

Reinforced allografts tendon for old injury of medial posterior structure of knee joint

目的探讨膝关节后内侧结构陈旧性损伤的手术治疗意义及方法的选择。方法自2004年1月始收治膝关节后内侧结构陈旧性损伤11例,患者均表现有膝部打软、关节不稳,伸膝位和屈膝30°位外翻应力试验>II°的阳性,Slocum试验阳性。2例患者曾行保守治疗,9例患者曾行手术前交叉韧带重建,后交叉韧带和内侧副韧带修补缝合术。2次手术间隔时间10～14个月。全部患者均一期重建内侧副韧带和后斜韧带,同时将内侧关节囊紧缩缝合,4例患者交叉韧带松弛,行RF紧缩。结果 11例患者1例术后3个月失访,余10例患者随访13～27个月。术后6个月和12个月行关节功能评定。外翻应力试验0°和屈膝30°位均正常8例;0°位正常,屈膝30°位表现为I°不稳2例。关节屈膝活动术后6个月(114±12)°,术后12个月(121±19)°。Lysholm评分术后6个月(88.26±4.37)分,术后12个月(92.03±0.91)分。手术前后比较差异有统计学意义(P<0.05)。IKDC评级:A级4例,B级5例,C级1例。术后12个月疗效评定:优良8例,中2例。结论膝关节后内侧结构的陈旧性损伤可导致膝关节的严重不稳定。选用同种异体肌腱加强手术重建后内侧结构的功能可较好地恢复膝关节的稳定性。

【Objective】To investigate the therapeutic effects and skills for treatment old injury of medial posterior structure of knee joint.【Methods】Since January 2004,A total of 11 cases with old injury of medial posterior structure of knee joint were administered and treated in our hospital.Of all,the symptoms were weakness of knee joint,unstable of action,over II° positive sign of eversion stress test in the position of 30 degree of extension and flexion and positive sign of Slocum test.2 cases were treated with conservative method and 9 cases were operated with ACL reconstruction and repairing of PCL and medial collateral ligament before our treatment.The interval duration of two operations were 10～14 months.Medial collateral ligaments and posterior oblique ligaments of all cases were reconstructed;medial articular capsule was reduced at the same time.RF reduce was used in 4 cases of cruciate ligament relax.【Results】Of all cases,the follow up data of 1 case were lost,11 cases were followed up,the period were 13～27 months,joint function was evaluated in 6 and 12 months after operation.8 cases were found that eversion stress test in the position of 0 and 30 degree were normal,2 cases were found that I degree unstable was existed.The domain of flexion action of joint after 6 and 12 months were（114±12）°and（121±19）°.Lysholm Score after 6 and 12 months were（88.26±4.37） and（92.03±0.91）,dominant difference was existed（P 0.05）.IKDC degree： A： 4 cases,B： 5 cases,C： 1 case.Therapeutic effect was that 8 cases were excellent and 2 cases were better.【Conclusions】Old injury of medial posterior structure of knee joint could induce action unstable seriously.Reinforced allografts tendon for treatment old injury of medial posterior structure of knee joint could recover the ideal function of knee joint stable.