关节镜辅助治疗难复性膝关节后外侧脱位的临床疗效

Clinical Outcomes of Arthroscopic-assisted Management for Irreducible Posterolateral Knee Dislocation

目的：探讨关节镜辅助治疗难复性膝关节后外侧脱位的临床疗效。方法：2009年1月至2014年5月,采用关节镜辅助治疗难复性膝关节后外侧脱位并随访2年以上患者13例,男8例,女5例;年龄27~56岁,平均37.8岁。受伤至手术时间1~3天,平均1.84天。所有患者于关节镜下复位后,一期重建前后交叉韧带并修复或重建损伤的内外侧副韧带。术后膝关节稳定性评价采用体格检查、KT-1000和Telos应力像,后两者测量结果根据IKDC膝关节检查表进行分类（正常、接近正常、异常和严重异常）;患者临床功能评价采用IKDC评分、Lysholm评分、Tegner评分和满意率。结果：随访时间为24~56个月,平均32.6个月。末次随访时,患者膝关节活动度为2.69°±5.63°~132.69°±11.66°。Lachman试验和轴移试验均阴性12例,均1＋阳性1例;后抽屉试验阴性11例,1＋阳性2例;屈膝30°位内翻应力试验阴性13例;屈膝30°位外翻应力试验阴性11例,1＋阳性1例,2＋阳性1例。KT-1000示患者膝关节前后向总位移和单纯前移的侧-侧差值分别为2.15±1.57 mm和1.61±0.86 mm。Telos应力像示术后前移侧-侧差值为2.23±0.92 mm,后移为3.23±1.16 mm,内侧间隙为1.77±1.87 mm,外侧间隙为0.46±0.52 mm。患者术前IKDC评分、Lysholm评分和Tegner评分分别为11.13±2.27分、1.31±2.59分和0.00±0.00分,术后分别为79.76±8.33分、84.53±6.39分和5.07±1.26分,术前术后临床功能评分差异均有统计学意义（t=27.02,P=0.001;t=45.72,P=0.001;t=14.58,P=0.001）。其中10例患者对术后临床疗效表示满意或非常满意,满意率为76.9%。多重线性回归示患者体重指数与术后临床疗效的相关性有统计学意义（t=-4.21,P=0.001）。结论：采用关节镜辅助治疗难复性膝关节后外侧脱位,一期重建前后交叉韧带并修复或重建损伤的内外侧副韧带,患者术后膝关节稳定性和临床功能较术前均有显著改善,患者术后满意率达76.9%。

Objective To evaluate the clinical outcomes of arthroscopic-assisted management of irre- ducible posterolateral knee dislocation. Methods From January 2009 to May 2014, 13 patients（8 male and 5 female）with irreducible posterolateral knee dislocation were treated and given follow-up no less than 2 years. The mean age of all the patients was 37.8 years（ranging from 27 to 56）. The mean time from injury to surgery was 1.84 days（ranging from 1 to 3 days）. All patients underwent one- stage arthroscopic reduction combined with multi-ligament reconstruction or repair. The postoperative knee stability was assessed using physical examinations, side-to-side differences （SSD）determined with KT-1000 arthrometer and Telos stress device. Other assessments included International Knee Documen- tation Committee（IKDC）subjective score,Lysholm score,Tegner score and satisfaction rate. Results The mean follow-up period was 32.6 months（ranging from 24 to 46 months）. At the final follow-up,the range of motion was between 2,69°±5.63° and 132.69°±11.66°. Except one patient who showed I de- gree positive in the Laehman test and pivot shift test,2 patients showing I degree positive in the poste- rior drawer test, as well as one I and II degree positive in the valgus stress test, all the other patients achieved negative or nearly negative results. The mean SSD of total anterior-posterior translation and isolated anterior translation determined with KT-1000 arthrometer were 2.15±1.57 mm（ranging 0-6 mm） and 1.61±0.86 mm（ranging 1-4 mm）respectively. The mean SSD of anterior translation,posterior transla- tion,medial and lateral joint gapping determined using Telos stress device were 2.23±0.92 mm（ranging 1-4 mm）,3.23±1.16 mm（ranging 2-5 mm）,1.77±1.87 ram（ranging 0-7 mm）and 0.46±0.52 mm（rang- ing 0-2 mm）. The IKDC subjective score,Lysholm score and Tegner score improved significantly from （11.13±2.27）,（1.31±2.59） and （0.00±0.00） to （79.76±8.33）,（84.53±6.39） and （5.07±1.26） postopera- tively（P=0.001）with a satisfaction rate of 76.9%（10/13）. Multiple linear regression indicated that the body mass index of patients was significantly correlated to their clinical outcomes. Conclusion One- stage arthroscopic-assisted reduction combined with multi-ligament reconstruction or repair was an effec- tive,reliable treatment for irreducible posterolateral knee dislocation.