前交叉韧带重建联合关节外侧肌腱固定治疗前交叉韧带损伤合并膝关节高度旋转不稳

Anterior cruciate ligament reconstruction combined with lateral extra-articular tenodesis for anterior cruciate ligament injury with high grade rotational instability

目的 探讨前交叉韧带重建联合关节外侧肌腱固定治疗前交叉韧带损伤合并膝关节高度旋转不稳的临床疗效。方法 回顾性分析自2020-01—2020-12采用前交叉韧带重建联合关节外侧肌腱固定术治疗的8例前交叉韧带损伤合并膝关节旋转不稳的患者资料。记录所有患者术前及末次随访时膝关节轴移试验分度和Lachman试验分度、IKDC主观评分和Lysholm膝关节评分并进行对比。结果 本组手术时间平均120(85~150)min,术中出血量平均10(5~20)mL,随访时间平均18.9(13~25)个月,均无神经血管损伤、下肢深静脉血栓形成、切口感染、坏死或不愈合等并发症发生。末次随访时,轴移试验均为阴性,Lachman试验仅有1例为1+,其余均为阴性,IKDC评分平均90.1(85~95)分,Lysholm评分平均90.9(86~95)分。结论 前交叉韧带重建联合关节外侧肌腱固定治疗前交叉韧带损伤合并膝关节高度旋转不稳的临床疗效良好,该联合术式可提升膝关节旋转及前后向稳定性,同时明显改善了膝关节功能。

Objective To explore the clinical efficacy of anterior cruciate ligament(ACL)reconstruction combined with lateral extra-articular tenodesis(LET)for treatment of ACL injury with high grade rotational instability.Methods From January 2020 to December 2020,a total of 8 consecutive ACL injured patients with high grade rotational instability who underwent ACL recon⁃struction combine with LET were reviewed retrospectively.The preoperative and final follow-up pivot-shift test,Lachman test,International Knee Documentation Committee(IKDC)scores,and Lysholm scores were recorded and compared.Results All enrolled patients were followed up with a mean follow-up time 18.9(13-25)months.No neurovascular injury,deep vein throm⁃bosis of lower extremity,wound infection,necrosis,nonunion or other complications occurred.At the final follow-up visit,the pivot-shift were all negative,the Lachman test were all negative except one 1+,the IKDC and Lysholm scores were 90.1(85-95)and 90.9(86-95)respectively.Conclusion For ACL injured patients with high grade rotational instability,combined ACL reconstruction and LET may obtain favorable clinical outcomes,the combined procedures could improve the rotational and ante⁃rior-posterior stability of the knee as well as the knee function.