膝关节内侧副韧带完全断裂时内侧副韧带深层损伤治疗方法比较

EFFICACY COMPARISON BETWEEN DEEP MEDIAL COLLATERAL LIGAMENT REPAIR AND CONSERVATIVE TREATMENT FOR COMPLETE MEDIAL COLLATERAL LIGAMENT RUPTURE

目的比较在膝关节内侧副韧带（medial collateral ligament,MCL）完全断裂时MCL深层（deep MCL,dMCL）缝合与保守治疗的效果。方法回顾2009年8月-2013年12月,收治并符合选择标准的36例3度MCL损伤患者临床资料。采用胫骨Inlay技术行MCL浅层（superior MCL,sMCL）重建同时,分别对dMCL采用缝合（缝合组,19例）或保守治疗（保守治疗组,17例）。两组患者性别、年龄、损伤侧别、致伤原因、病程及术前内侧关节间隙开口、膝关节Lysholm评分、国际膝关节文献委员会（IKDC）评分等一般资料比较,差异均无统计学意义（P〉0.05）,具有可比性。两组患者术后行内侧关节间隙开口检测评价膝关节稳定性,并记录膝关节活动度、疼痛视觉模拟评分（VAS）、Lysholm评分及IKDC评分评估膝关节功能。结果术后两组患者切口均Ⅰ期愈合,无切口感染、下肢深静脉血栓形成等术后早期并发症发生。两组患者均获随访,缝合组随访时间为28-65个月,平均46.3个月;保守治疗组为26-69个月,平均45.9个月。两组均无膝关节僵直、血管或神经损伤及膝关节感染等并发症发生。术后2年,两组膝关节活动度比较差异无统计学意义（t=0.26,P=0.80）;缝合组VAS评分显著优于保守治疗组,差异有统计学意义（t=5.22,P=0.00）。术后2年两组膝关节内侧关节间隙开口、IKDC评分及Lysholm评分均较术前显著改善,差异有统计学意义（P〈0.05）;但两组间比较差异均无统计学意义（P〉0.05）。结论采用胫骨Inlay技术重建sMCL后,dMCL缝合与否均能恢复膝关节内侧稳定性;但dMCL缝合有利于降低术后膝关节内侧疼痛。

Objective To compare the clinical efficacy between deep medial collateral ligament（dMCL） repair and conservative treatment for complete MCL rupture. Methods Between August 2009 and December 2013, 36 patients with grade 3 MCL rupture underwent superior MCL（sMCL） reconstruction with tibial Inlay technique. Of 36 cases, 19 received dMCL repair（repair group）, and 17 received conservative treatment（conservation group） after sMCL reconstruction. There was no significant difference in gender, age, knee sides, type of injury, disease duration and preoperative medial joint opening, knee Lysholm scores, and International Knee Documentation Committee（IKDC） score between 2 groups（P〉0.05）. The Lysholm and IKDC scores, medial joint opening, range of motion（ROM）, visual analogue scale（VAS） scores, and complications were used to assess the knee joint function. Results All patients achieved primary incision healing without acute postoperative complications of incision infection and deep vein thrombosis in the lower limb. The patients were followed up 28-65 months（mean, 46.3 months） in the repair group, and 26-69 months（mean, 45.9 months） in the conservation group. No knee stiffness, vascular or nerve injury, and knee joint infection occurred in 2 groups. All the patients recovered medial stability at 2 years postoperatively. At 2 years after operation, no significant difference was shown in knee ROM between 2 groups（t=0.26, P=0.80）; the VAS score of the repair group was significantly lower than that of the conservation group（t=5.22, P=0.00）; medial joint opening, IKDC score, and Lysholm score were significantly improved when compared with preoperative ones in 2 groups（P〈0.05）, but no significant difference was found between 2 groups（P〉0.05）. Conclusion Whether or not additional dMCL repair is performed can recover medial stability after sMCL reconstruction. However, the additional dMCL repair is better in relieving medial knee pain than the conservative treatment.