关节镜下前交叉韧带重建术后早期并发症的预防及治疗

Prevention and treatment of early complications after arthroscopic anterior cruciate ligament reconstruction

目的 探讨在关节镜下应用自体腘绳肌腱重建前交叉韧带术后早期并发症的预防及治疗策略。方法 自2011-01—2013-02应用自体四股腘绳肌腱重建前交叉韧带治疗286例前交叉韧带损伤,重建韧带的股骨侧用Rigidfix横穿钉固定,胫骨侧用Intrafix带鞘螺钉固定,术后15例出现并发症（感染、下肢深静脉血栓形成、患肢肿胀、隐神经损伤）,经过积极治疗,采用Lysholm、IKDC关节评分评价疗效。结果 所有患者均获得随访12~24个月,平均18个月。随访期间无内固定物松动。患者术后患膝主动屈伸膝角度接近正常。术后仅1例前抽屉试验弱阳性,所有患者Lachman试验征均为阴性,轴移试验均阴性。Lysholm关节评分由术前（45.31±5.36）分提高到术后（85.02±5.13）分（t=-8.91,P=0.005）,IKDC评分由术前（40.15±12.16）分提高到术后（82.47±3.52）分（t=-4.23,P=0.031）,差异均有统计学意义。结论 关节镜下重建前交叉韧带术后并发症并不罕见,需要早期采取预防措施,一旦出现需及时治疗,以促进关节功能的恢复。

Objective To investigate preventive and therapeutic strategy on early complications after arthroscopic anterior eruciate ligament reconstruction with autogenous hamstring tendon. Methods From January 2011 to February 2013, 286 cases of anterior cruciate ligament injury were treated with four-stand hamstring tendon autograft. There were 15 cases following postoperative complications： infection, deep venous thrombosis of lower extremity, swelling of the affected limb, and saphenus nerve injury. Through positive treatment, strengthening functional exercise and other methods, clinical results of the patiens were evaluated by Lyshlom score scale and IKDC score. Results All the patients were followed up for average of 18 months. Lysholm scale of the knee function was （45.31±5.36） preoperatively and （85.02±5.13） postoperatively（P 〈0.05）. IKDC score： prc -operative （40.15 ± 12.16）; post -operative （82.47±3.52） （P 〈0.05 ）. The difference was significant. Symptoms were relieved and the functions of knee joint were improved. The anterior drawer test was weak positive n one case. Lachman test of all cases was negative, and the pivot-shift test was negative. Conclusion Postoperative complication of arthroscopic anterior cnlciate ligament reconstruction is not rare. Early prevention and timely treatment can obtain satisfactory curative effect.