膝关节多发韧带伤关节镜下同期重建的疗效分析

Analysis of the effect of simultaneous reconstruction of knee joint multiple ligament injury under arthroscopy

目的探讨关节镜下同期治疗膝关节多发韧带损伤的手术方法及疗效.方法回顾性分析2008年3月-2017年12月行关节镜下同期治疗膝关节多发韧带损伤的患者22例.其中,男15例,女7例,年龄21~60岁,平均(40.1±12.5)岁.所有患者术前均行患侧膝关节磁共振成像(MRI)明确多发韧带损伤.手术均采用自体或异体肌腱,在关节镜下重建前交叉韧带(ACL)和后交叉韧带(PCL),同时修补内侧副韧带16例,外侧副韧带2例.2例合并下肢骨折,先行骨折复位固定,术后1和3个月行关节镜手术韧带重建修补.手术前后根据国际膝关节文献委员会(IKDC)评分、Lysholm及Tegner膝关节评分评价关节功能,并采用视觉模拟评分法(VAS)评估患者疼痛情况.结果所有病例均成功行关节镜下同期重建修补.随访5~48个月,平均25个月,末次随访膝关节Lysholm评分明显高于术前[(85.10±6.40)和(21.60±7.90)分,t=34.80,P=0.000];IKDC评分及Tegner评分明显高于术前[(79.99±5.12)和(20.64±8.35)分,t=28.41,P=0.000;(3.77±1.15)和(0.45±0.51)分,t=12.36,P=0.000];VAS评分术后与术前比较,差异有统计学意义[(0.45±0.60)和(6.73±1.32)分,t=-20.37,P=0.000].结论膝关节多发韧带损伤同期关节镜下行前、后交叉韧带重建及侧副韧带修补,能有效恢复关节稳定性,治疗效果满意.

Objective To investigate the therapeutic effects of arthroscopic reconstruction in treatment of multiligaments injuries of knee joint. Methods From March 2008 to December 2017, 22 patients with multiple ligaments injuries of knee underwent arthroscopic reconstruction, including 15 males and 7 females with the average age of (40.1 ± 12.5) years old (ranging from 21 ~ 60 years old), whose anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) were reconstructed by autologous or allogenic tendons under arthroscopy and whose medial collateral ligament (MCL) or lateral collateral ligament (LCL) were repaired at the same time. 16 patients were treated with augmentation of MCL and 2 patients were treated with repair the LCL in addition to reconstruct ACL and PCL. 2 of them underwent early fracture fixation operations for combination of the lower limb fractures and received the arthroscopic operations after one and three months. The international knee documentation committee (IKDC), Lysholm knee score and Tegner activity scale were used for function evaluation. Ache situation was assessed by visual analogue scale (VAS). Results All the patients obtained successful arthroscopic reconstruction and repair. With an average follow-up of 25 months (5 ~ 48 months), there were significant difference between the last visit and pre-operation in Lysholm score [(85.10 ± 6.40) vs (21.60 ± 7.90), t = 34.80, P = 0.000];IKDC score [(79.99 ± 5.12)vs (20.64 ± 8.35), t = 28.41, P = 0.000] and Tegner score [(3.77 ± 1.15) vs (0.45 ± 0.51), t = 12.36, P = 0.000] were significantly higher than that before surgery;The difference in the VAS scale [(0.45 ± 0.60) vs (6.73 ± 1.32), t =-20.37, P = 0.000] was statistically significant. Conclusion Arthroscopic reconstruction of ACL and PCL combined with repair or augmentation of the MCL and LCL simultaneously can obtain good stability and satisfying clinical results.