内侧副韧带Ⅱ度损伤保守或手术修复对前交叉韧带重建后膝关节前后稳定性的影响

Effects of grade Ⅱ medial collateral ligament injury on anterior-posterior stability of knee after anterior cruciate ligament reconstruction: surgery versus conservative treatment

目的探讨Ⅱ度内侧副韧带(MCL)损伤手术或保守治疗对前交叉韧带(ACL)重建前后稳定性的影响。方法以54例膝关节ACL合并急性Ⅱ度MCL损伤患者为研究对象,所有患者受伤时间均<1周,术前MRI检查示ACL连续性中断,MCL股骨、胫骨止点高信号,术前查体示前抽屉试验阳性,0°外翻应力试验阴性,30°外翻应力试验阳性。对所有患者术前行KT1000测量胫骨相对股骨前移度,膝关节活动度(ROM),IKDC主观评分。将所有患者随机分为A、B两组,对A组患者采取关节镜下ACL异体单束重建+MCL切开修复术;B组行单纯ACL异体单束重建,MCL采取支具固定保守治疗6周。术后1年对所有患者行IKDC评分、ROM测量、KT1000评价临床效果。结果所有患者术后1年IKDC评分、KT 1000测量较术前均有统计学差异(t=13.699,9.553;P<0.05);A组患者IKDC主观评分与B组比较结果无统计学差异(2=6.273,P>0.05),两组患者术前术后关节活动度无统计学差异(t=0.672,P>0.05),A组患者术后膝关节前后稳定性改善(KT 1000测量值)较B组明显改善,且结果比较有统计学意义(t=0.932,P<0.05)。结论膝关节Ⅱ度MCL损伤合并ACL损伤建议MCL修复+ACL重建一期手术完成。

Objective To observe the effects of grade Ⅱ medial collateral ligament（MCL） injury treated by surgery or conservative treatment on the axial stability after the anterior cruciate ligament reconstruction. Methods 54 cases of the anterior cruciate ligament injury with acute grade Ⅱ medial collateral ligament injury were chosen for the study. All the patients had been injured for less than one week. The preoperative MRI examination showed discontinuity of the anterior cruciate ligament, and high signals for the femoral and tibial insertions of the medial collateral ligament. The preoperative examination revealed that 30° valgus stress test and the anterior drawer test were positive, while 0° valgus stress test was negative. All the patients were randomly divided into two groups. All the patients were evaluated by KT 1000 measurement for anterior tibial translocation, the range of motion （ROM） of the knee, and IKDC scores. The arthroscopic single-bundle allograft reconstruction of the anterior cruciate ligament was performed both in group A and group B, while the medial collateral ligament was open repaired in the group A, and a 6-week brace fixation was used as a conservative treatment for MCL injury in the group B. All the patients underwent clinical effects assessment by IKDC score, ROM measurement, KT1000 measurement one year after the surgery. Results One year after the surgery, the improvement of IKDC score and the KT1000 measurement was significant in all patients compared with the preoperative data （ P 〈 0. 05 ）.There was no significant difference between the group A and the group B in IKDC score （P 〈 0. 05 ）. There was no significant difference （ P 〉 0. 05, t = 0. 672 ） between the two groups in the preoperative and postoperative joint activities. The axial stability after the operation was remarkably improved in the group A comparing with the group B, which was statistically significant （ P 〈 0. 05）. Conclusion It is suggested that the repair of grade Ⅱ medial collateral ligament injury should be adopted along with the reconstruction of the anterior cruciate ligament.