膝关节急性后内侧角损伤的关节镜下诊断

Diagnosis of acute posteromedial corner injury of knee joint under arthroscope

目的研究急性膝关节后内侧角(PMC)损伤患者膝关节镜下的表现,探讨利用关节镜技术帮助诊断。方法收集2017年4月-2017年8月因外伤行膝关节镜手术的7例急性膝关节PMC损伤患者资料进行回顾性研究,治疗均在同一治疗组进行。其中,男4例,女3例,年龄37~59岁,平均49.6岁。所有入选患者术前磁共振成像(MRI)提示内侧副韧带损伤,术前评估视觉模拟疼痛评分(VAS)。体检膝关节屈曲30°时及0°外翻位应力试验均为阳性。术中进行关节镜下探查,确认膝关节PMC损伤,7例均行内侧半月板后角成形术或者缝合术、内侧副韧带及后内侧角锚钉修补术。术前测量患膝及术后2个月测量双膝关节屈曲30°时及0°外翻位应力X线,评估患膝VAS评分。结果 7例患者随访时间为2个月,无一脱落。关节镜下探查发现:7例均能轻松观察到内侧半月板后角、5例出现内侧半月板后角容易抬起;7例均出现半月板周围关节囊韧带复合体损伤。膝关节内侧间隙术前与术后2个月在膝关节外翻应力屈曲30°比较差异有统计学意义[(9.2±1.3)vs(3.0±1.0)mm,P<0.05];膝关节内侧间隙术前与术后2个月在膝关节外翻应力0°比较差异有统计学意义[(8.8±1.1)vs(2.9±1.0)mm,P<0.05]。术后2个月在膝关节外翻应力屈曲30°与健侧膝比较差异无统计学意义[(3.0±1.0)vs(2.9±1.2)mm,P>0.05];术后2个月在膝关节外翻应力0°与健侧膝比较差异无统计学意义[(2.9±1.0)vs(2.8±1.2)mm,P>0.05]。术前与术后2个月膝关节疼痛VAS评分比较差异有统计学意义[(5.4±0.3)vs(2.3±1.1)分,P<0.05]。结论关节镜下探查急性膝关节损伤患者,如果轻松观察到内侧半月板后角、内侧半月板后角容易上抬、内侧半月板后角周围出现关节囊及韧带损伤等表现均提示急性PMC损伤,及时进行半月板损伤关节镜下处理及修复PMC,膝关节可获得满意的稳定性。

Objective To study the performance of knee arthroscopy in patients with acute posteromedial corner injury and to explore the use of arthroscopy to help diagnosis. Methods From April to August 2017, the arthroscopic posteromedial corner after operation of 7 cases of acute knee joint injury patients data were retrospectively studied, treatment are in the same group. They were two man and three women, 37 - 59 years of old （average 49.6 years）. All patients were selected for preoperative MRI to indicate medial collateral ligament damage. The VAS score was evaluated preoperative. When check-up knee flexion and 30° valgus stress test positive and 0° valgus stress test positive. Intraoperative arthroscopy was performed to confirm the injury of the Posteromedial corner. The medial meniscus was formed or stitched. The medial collateral ligament and Posteromedial corner were repaired. The knee X-ray examination were measured preoperative and in 2 months after surgery, Evaluation of the knee VAS score in 2 months after surgery. Results All patients were followed up for 2 months. The medial meniscus were easily observed and raise easily 5 cases undergoing arthroscopic surgery. All 7 patiens were showed the injury of the joint capsule ligament complex. All of the 7 cases showed the injury of the joint capsule ligament complex. Preoperative and postoperative knee medial clearance for 2 months in knee valgus stress buckling 30° [（9.2 ± 1.3） vs （3.0 ± 1.0） mm]. Preoperative and postoperative knee medial clearance for 2 months in knee valgus stress 0° [（8.8 ± 1.1） vs （2.9 ± 1.0） mm]. There were statistically significant differences （P 〈 0.05）. After 2 months in knee valgus stress buckling is compared with the normal control group 30° [（3.0 ± 1.0） vs （2.9 ± 1.2） mm]. After 2 months in 0° knee valgus stress compared with normal control group [（2.9 ± 1.0） vs （2.8 ± 1.2） mm]. There was no statistical difference （P 〉 0.05）. Preoperative and postoperative knee joint pain VAS score [（5.4 ± 0.3） vs （2.3 ± 1.1）]. There were statistically significant differences （P 〈 0.05）. Conclusion Under arthroscopy detection in patients with acute Posteromedial corner injury. If it is easy to observe posterior horn of medial meniscus and the medial meniscus angle is easy to raise; The medial meniscus posterior horn joint capsule and ligament damage. They were indicated acute Posteromedial corner injury. Timely deal with medial meniscus and repair Posteromedial corner, the stability of the knee joint can be satisfactory.