膝关节脱位致多韧带损伤Ⅰ期修复重建的疗效

Effect of primary repair and reconstruction of grade Ⅰ multiple ligament injury caused by dislocation of knee joint

目的:探讨膝关节脱位致膝关节前、后交叉韧带及内侧副韧带损伤后一期修复的疗效。方法:回顾性分析28例膝关节脱位致膝关节前、后交叉韧带损伤及合并内侧副韧带Ⅲ度损伤或完全断裂的患者行Ⅰ期修复重建的疗效。其中车祸事故伤22例,军事训练伤4例,高台坠落伤2例。损伤至手术时间6~17(平均7)d。膝关节Lysholm评分为21.7±6.52,国际膝关节文献委员会(International Knee Documentation Committee,IKDC)评分为17.42±11.56,关节活动范围为(27.2±19.6)°。合并内外侧半月板复合裂伤15例。通过关节镜下探查清理关节腔周围合并损伤后,采用患者自体半腱肌股薄肌肌腱重建前交叉韧带(anterior cruciate ligament,ACL),人工韧带(ligament advanced reinforcement system,LARS),韧带重建后交叉韧带(poster cruciate ligament,PCL),并使用带线锚钉修复内侧副韧带(medial cruciate ligament,MCL)。结果:患者出院后均获随访,随访时间为6~24(平均18.2)个月。术后2年Lysholm膝关节功能评分为89.23±9.23,关节活动范围116.56°±12.8°,IKDC评分为88.74±8.74,与术前评分对比差异有统计学意义(P<0.05)。结论:在膝关节脱位致多韧带损伤的治疗方案中,Ⅰ期关节镜下行ACL和PCL重建术,并使用带线锚钉修补MCL断端,患者受到的损伤小,术后膝关节的稳定性恢复佳,通过进一步的康复理疗,关节粘连发生率较低,可得到相对满意的近期疗效,此方法值得临床参考并借鉴。

Objective： To summarize and discuss the dislocation of the knee joint caused by anterior and posterior cruciate ligament injury and reconstruction combined with rivet repair of medial collateral ligament of knee joint injury, curative effect to restore stability and function. Methods： Effect of stage I arthroswpic on 28 patients with knee joint dislocation, anterior and posterior cruciate ligament injuries and patients with secondary or complete rupture of the medial collateral ligament were retrospectively analysed. There were 22 cases of car accident injury, 4 cases of military training injury and 2 cases of plateau falling injury. Xhe injury time was 6-17 d, with an average of 7 d. Xhe knee joint Lysholm score was 21.7±6.52 and the International Knee Documentation Committee （IKDC） score was 17.42 ±11.56, and the range of motion of the joint was （27.2±19.6） degrees. Combined internal and external meniscus composite laceration were in 15 cases. After arthroscopic debridement, the joint cavity was combined with iniury, and the autogenous semitendinosus tendon and gracilis gracilis tendon were used to reconstruct ACL, LARS ligament and PCL, and MCL was repaired with suture rivet. Results： All patients were followed up in a short time for 6 to 24 months, with an average of 18.2 months. Tae knee function score of Lysholm was 89.23±6.08, and the range of joint motion was 116.56°±12.8°, and the IKDC score was 88.74±4.54. The difference was statistically significant （P〈0.05）. Conclusion： In the treatment of multiple ligament injury caused by knee dislocation, patients were less in）ured by the reconstruction of ACL and PCL under one-stage arthroscopic, combined with the incision and repair the MCL tight end, and postoperative knee stability recover better. Further rehabilitation therapy may obtain significantly lower joint adhesion rate and short-term effect, which is worthy of clinical reference.