关节镜下一期治疗膝关节多发韧带损伤35例

One-Stage Arthroscopic Treatment for 35 Cases of Multiple Ligament Injuries of the Knee Joint

目的:探讨关节镜下一期修复重建膝关节多发韧带损伤的疗效。方法:2014年8月至2018年12月,对35例膝关节多发韧带损伤患者,采用关节镜下自体腘绳肌腱结合TightRope钢板重建前后交叉韧带,联合有限切开修复重建后内侧角或后外侧角,同时处理合并伤。随访期间,通过关节稳定性检查、Lysholm评分及国际膝关节文献委员会(IKDC)膝关节主观评分对患者膝关节功能进行评价。结果:35例患者术后均获得随访,随访时间12~48个月,平均26.1个月。术中发生腘动脉外侧壁损伤1例,术中予以修补;合并半月板损伤10例,予以半月板成形术或缝合修复术;1例腓总神经损伤患者术中探查其神经连续性完整。术后1例外侧切口愈合不良,清创后愈合;其他患者均Ⅰ期愈合。末次随访,患者膝关节Lysholm评分及IKDC评分与术前比较改善明显,差异均有统计学意义(P<0.05)。结论:关节镜下一期修复重建膝关节多发韧带损伤,具有微创便捷、固定牢固、住院周期短等优点,可较好恢复膝关节的稳定性及功能。

Objective:To investigate the clinical efficacy of one-stage arthroscopic repair and reconstruction for multiple ligament injuries of the knee joint.Methods:From August 2014 to December 2018,35 patients with multiple ligament injuries of the knee joint were treated.Anterior cruciate ligament(ACL)and posterior cruciate ligament(PCL)were reconstructed by autologous hamstring tendons combined with TightRope suspension plates under an arthroscopy.Limited incision was performed to reconstruct medial and posterior lateral part of cartilage injury.Meanwhile,the associated injuries were treated.During the follow-up period,the joint stability examination,Lysholm score and IKDC knee subjective score were used for knee functional evaluation.Results:All 35 patients were successfully followed up after the operation for 12 to 48 months,with an average of 26.1 months.Intraoperative popliteal artery lateral wall injury occurred in 1 case,which was intraoperatively repaired.Meniscus injury was combined in 10 cases,and meniscus plasty or suture repair were performed.The nerve continuity of 1 patient with common peroneal nerve injury was investigated to be complete during the operation.One of the side incisions healed poorly after operation,and the wound healed after debridement.The other patients were healed by first intention.At the last follow-up,the knee Lysholm score and IKDC score were obviously improved compared with those before surgery,and the differences were statistically significant(P<0.05).Conclusion:One-stage arthroscopic repair and reconstruction for multiple ligament injuries of the knee joint has the advantages of minimally invasive and convenient,solid fixation,and short hospitalization period.It can better restore the stability and function of the knee joint.