改良Laprade法重建韧带治疗膝关节外侧损伤的近期疗效

A modified Laprade technique in treatment of lateral multi-ligament injuries of knee

目的探讨改良Laprade法重建后外侧结构以及前外侧韧带治疗膝关节外侧损伤的近期疗效。方法 2013年6月—2015年7月,收治13例膝关节多发韧带损伤患者。男9例,女4例;年龄23~49岁,平均38岁。交通事故伤7例,高处坠落伤4例,运动伤2例。损伤至手术时间18~92 d,平43 d。患者前、后抽屉试验及Lachman试验均呈阳性,伴内翻、前后外旋不稳。膝关节Lysholm评分为(38.4±7.7)分。国际膝关节文献委员会(IKDC)综合评分均为D级。后外侧结构损伤根据Fanelli分型标准,均为C型。术中取健侧自体肌腱,关节镜下重建前、后交叉韧带,并联合后外侧切口行改良Laprade法重建后外侧结构及前外侧韧带。结果术后切口均Ⅰ期愈合。患者均获随访,随访时间12~36个月,平均19个月。末次随访时,患者前、后抽屉试验及Lachman试验均呈阴性;2例内翻不稳,1例后外旋转不稳。无前外旋转不稳定。膝关节Lysholm评分为(88.6±12.7)分,与术前比较差异有统计学意义(t=13.852,P=0.000)。IKDC综合评分:A级8例,B级4例,C级1例;与术前比较差异有统计学意义(Z=3.182,P=0.000)。结论对于膝关节外侧损伤,应用自体肌腱采用改良Laprade法解剖重建后外侧结构及前外侧韧带,可获得较好近期疗效。

Objective To evaluate the short-term effectiveness of a modified Laprade technique in the treatment of lateral multi-ligament injuries of knee by anatomical reconstruction of posterolateral complex （PLC） and anterior lateral ligament （ALL）. Methods Between ]une 2013 and July 2015, 13 cases of lateral multi-ligament injuries of knee were treated. There were 9 males and 4 females with an average age of 38 years （range, 23-49 years）. The injury was caused by traffic accident in 7 cases, falling from height in 4 cases, and sport injury in 2 cases. The time between injury and operation was 18-92 days （mean, 43 days）. The results of anterior and posterior drawer tests and Lachmann test were positive, and all cases complicated by varus and external rotation instability. The Lysholm score of the knee was 38.4±7.7. According to International Knee Documentation Committee （IKDC） scoring, all were rated as grade D. According to Fanelli classification criteria, all were classified as type C. Anterior cruciate ligament, posterior cruciate ligament, PLC, and ALL were reconstructed simultaneously with autogenous tendon. Results All incisions healed at stage I and no complication occurred. All patients were followed up 12-36 months （mean, 19 months）. At last follow-up, the results of anterior and posterior drawer tests and Lachmann test were negative; 2 cases had varus instability, and 1 cases had external rotation instability. There was no anterior external rotation instability. The Lysholm score of the knee was 88.6 _＋12.7, showing significant difference when compared with preoperative score （t=13.852, P=0.000）. According to IKDC scoring, 8 cases were rated as grade A, 4 as grade B, and 1 as grade C; significant difference was found when compared with preoperative value （Z=3.182, P=0.000）. Conclusion In the treatment of lateral multi-ligament injuries knee, anatomical reconstruction of PLC and ALL with a modified Laprade technique can obtain good short-term effectiveness.