关节镜下内侧副韧带锚钉缝合固定联合前后交叉韧带重建治疗KD-ⅢM型膝关节脱位的疗效

Efficacy of arthroscopic anchor fixation of medial collateral ligament combined with anterior and posterior cruciate ligament reconstruction in the treatment of type KD-ⅢM dislocation of knee joint

目的比较关节镜下内侧副韧带(MCL)锚钉缝合固定与不修复联合前后交叉韧带重建治疗KD-ⅢM型(Schenck分型)膝关节脱位的临床疗效。方法采用回顾性病例对照研究分析2015年9月至2017年9月西安交通大学附属红会医院收治的41例KD-ⅢM型膝关节脱位患者的临床资料,其中男26例,女15例;年龄15~62岁[(37.7±13.9)岁]。21例关节镜下前后交叉韧带重建加MCL锚钉缝合固定(修复组);20例关节镜下前后交叉韧带重建,MCL不予修复(未修复组)。观察围术期并发症。比较两组术前、术后4个月及末次随访时Lysholm评分、国际膝关节文献委员会(IKDC)评分、视觉模拟评分(VAS)及关节屈伸活动度,以及末次随访时双下肢应力X线片的内侧开口距离。结果患者均获随访48~66个月[(54.4±5.1)个月]。均未见围术期并发症。两组间术前Lysholm评分、IKDC评分、VAS及关节屈伸活动度差异均无统计学意义(P>0.05),两组内术后4个月及末次随访时以上相关指标均较术前明显改善(P<0.05)。修复组术后4个月和末次随访时Lysholm评分为(69.7±5.1)分和(83.8±4.9)分,较未修复组的(61.0±5.5)分和(74.6±6.0)分显著提高(P<0.05)。修复组术后4个月IKDC评分为(71.8±4.0)分,较未修复组的(71.1±3.9)分显著提高(P<0.05);末次随访时IKDC评分为(82.3±5.1)分,与未修复组的(83.2±4.0)分差异无统计学意义(P>0.05)。修复组术后4个月VAS为(2.5±0.6)分,较未修复组的(3.2±1.2)分显著降低(P<0.05);末次随访时VAS为(2.0±1.4)分,与未修复组的(2.2±1.3)分差异无统计学意义(P>0.05)。修复组术后个4个月和末次随访时关节屈伸活动度为(107.6±6.9)°和(125.9±7.8)°,较未修复组的(89.6±4.0)°和(120.9±5.2)°显著增加(P<0.05)。修复组末次随访时内侧开口距离为(2.3±0.2)mm,较未修复组的(3.1±0.2)mm显著降低(P<0.05)。结论关节镜下MCL锚钉缝合固定或不修复联合前后交叉韧带重建治疗KD-ⅢM型膝关节脱位均可获得较为满意功能恢复,但MCL修复的患者功能恢复、疼痛缓解更快,关节稳定性更加可靠。

Objective To compare the clinical effect of anchor fixation of medial collateral ligament(MCL)and non-repaired treatment combined with arthroscopic anterior and posterior cruciate ligament reconstruction in the treatment of type KD-IIIM(Schenck classification)dislocation of knee joint.Methods A retrospective case-control study was conducted to analyze the clinical data of 41 patients with type KD-ⅢM dislocation of the knee joint admitted to Xi'an Honghui Hospital of Xi'an Jiaotong University from September 2015 to September 2017.There were 26 males and 15 females,with the age range of 15-62 years[(37.7±13.9)years].A total of 21 patients were treated by arthroscopic anterior and posterior cruciate ligament reconstruction and anchor fixation of MCL(repaired group)and 20 patients by arthroscopic anterior and posterior cruciate ligament reconstruction without MCL repair(non-repaired group).The perioperative complications were observed.Comparisons between the two groups were made before operation,4 months after operation and at the last follow-up in terms of Lysholm score,International Knee Documentation Committee(IKDC)score,Visual Analogue Scale(VAS)and range of motion of joint flextion and extension.The medial opening distance of stress X-ray of lower limbs was also obsened at the last follow-up.Results All patients were followed up for 48-66 months[(54.4±5.1)months].No perioperative complications were noted.The Lysholm score,IKDC score,VAS and range of motion of joint flextion and extension showed no statistical differences between the two groups before operation(P>0.05),and all were improved from the preoperative level at 4 months after operation and at the last follow-up(P<0.05).The Lysholm score in repaired group were(69.7±5.1)points and(83.8±4.9)points at 4 months after operation and at the last follow-up,significantly higher than those in non-repaired group[(61.0±5.5)points and(74.6±6.0)points](P<0.05).The IKDC score in repaired group was(71.8±4.0)points at 4 months after operation,significantly higher than that in non-repaired group[(71.1±3.9)points](P<0.05).The IKDC score in repaired group was(82.3±5.1)points at the last follow-up,similar with that in non-repaired group[(83.2±4.0)points](P>0.05).The VAS in repaired group was(2.5±0.6)points at 4 months after operation,significantly decreased in comparison with(3.2±1.2)points in non-repaired group(P<0.05).The VAS in repaired group was(2.0±1.4)points when compared to(2.2±1.3)points in non-repaired group at the last follow-up(P>0.05).The range of motion of joint flextion and extension in repaired group was(107.6±6.9)°and(125.9±7.8)°at 4 months after operation and at the last follow-up,significantly increased in comparison with(89.6±4.0)°and(120.9±5.2)°in non-repaired group(P<0.05).The medial opening distance in repaired group was(2.3±0.2)mm at the last follow-up,significantly decreased when compared to(3.1±0.2)mm in non-repaired group(P<0.05).Conclusion For type KD-IIIM knee dislocation,arthroscopic anchor fixation of MCL or without MCL repair combined with anterior and posterior cruciate ligament reconstruction are both effective in satisfactory functional recovery,hut MCL repair contributes to earlier function recovery,faster pain relief and more reliable joint stability.