改良Laprade术式重建膝关节后外侧复合体联合关节镜下重建后交叉韧带的早期疗效分析

Modified Laprade posterolateral complex reconstruction combined with arthroscopic reconstruction of posterior cruciate ligament

目的研究膝关节后交叉韧带合并后外侧复合体联合损伤中后外侧复合体解剖重建方法及早期疗效。方法回顾性分析2017年1月-2019年1月西南医科大学附属医院收治的膝后交叉韧带伴后外侧复合体损伤的患者16例,术中关节镜下使用人工韧带重建后交叉韧带,取自体半腱肌、股薄肌,使用改良Laprade术式同期重建后外侧复合体。观察记录手术前后X线应力位片胫骨后移距离与外侧间室撑开距离、拨号试验外旋角度、膝关节活动度及术后并发症发生情况,根据国际膝关节文献委员会(International Knee Documentation Committee,IKDC)分级、Lysholm膝关节评分评价治疗前后关节功能。结果 16例患者均获随访,随访时间为12~25个月,平均17个月。至末次随访,X线片示后向应力下胫骨后移距离[(18.42±4.93) vs.(3.63±2.37) mm]、内翻应力下外侧间室撑开距离[(13.70±3.19)vs.(3.28±1.89) mm]、屈膝30°拨号试验胫骨外旋角度[(14.75±2.84)vs.(2.44±2.06)°]、屈膝90°拨号试验胫骨外旋角度[(15.94±2.52)vs.(2.72±2.14)°]较术前值明显减小,Lysholm膝关节评分[(45.42±10.94)vs.(85.19±7.11)分]和IKDC分级较术前有明显改善,上述指标差异皆有统计学意义(P<0.05)。术后13例患者膝关节活动度恢复正常,3例患者出现0~10°屈曲功能受限。无一例患者出现感染、内固定松动、神经损伤等并发症。结论使用改良Laprade术式重建膝关节后外侧复合体并同期联合关节镜下后交叉韧带重建能有效恢复膝关节后方与后外旋转的稳定性,值得临床推广。

Objective To study the anatomic reconstruction method of posterolateral complex(PLC) in combination injury of posterior cruciate ligament(PCL) and PLC of knee, and explore its early clinical effect.Methods A total of 16 patients(10 males and 6 females) with PCL and PLC injuries admitted to the Affiliated Hospital of Southwest Medical University between January 2017 and January 2019 were retrospectively analyzed. The PCL was reconstructed with artificial ligament under arthroscopy, and autologous semitendinosus and gracilis muscles were used to reconstruct the PLC using the modified Laprade procedure. We measured the tibia posterior displacement on stress radiographs, lateral compartment gapping on varus stress radiographs, external rotation angle of tibia, and range of motion(ROM) of knee before and after operation, observed and recorded the postoperative complications, and evaluated the joint function according to the score of International Knee Documentation Committee(IKDC) and Lysholm Knee score before and after operation. Results All the 16 patients were followed up for 12 to 25 months, with an average of 17 months. The stress radiographs at the last follow-up showed that the tibia posterior displacement [(18.42±4.93) vs.(3.63±2.37) mm], lateral compartment gapping [(13.70±3.19) vs.(3.28±1.89) mm], external tibial rotation at 30° and 90° of flexion [30°:(14.75±2.84) vs.(2.44±2.06)°;90°:(15.94±2.52) vs.(2.72±2.14)°] were significantly reduced compared with those before surgery. Lysholm score(45.42±10.94 vs. 85.19±7.11) and IKDC grade were obviously improved compared with those before surgery. All the above indicators showed statistically significant differences(P<0.05). The postoperative ROMs of knees of 13 patients returned to normal, and 0-10° flexural function was limited in 3 patients. None of the patients suffered from infection, loose internal fixation, nerve injury, or other complications. Conclusion Modified Laprade PLC reconstruction combined with arthroscopic reconstruction of PCL can effectively restore the posterior and posterolateral rotatory stability of the knee, and is worthy of clinical promotion.