关节镜下一期人工韧带治疗膝关节多发韧带损伤
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摘要
目的探讨一期关节镜下应用人工韧带治疗膝关节多发韧带损伤的疗效。方法回顾性分析2014年1～12月膝关节多发韧带损伤(SchenckⅢ型)19例资料。手术距受伤时间6～18 d,平均11.6 d。均一期在关节镜下应用LARS人工韧带(Ligament Advanced Reinforcement System)重建前和(或)后交叉韧带。采用膝关节Lysholm评分、Tegner评分评定疗效。结果 19例术后随访22～28个月,平均24.5月。无膝关节感染、韧带断裂、韧带松弛等。末次随访时,膝关节Lysholm评分(85.6±2.2)分,Tegner评分(5.4±1.1)分,均较术前(33.2±2.3)分及(2.4±0.9)分明显提高(配对t检验,t=-22.422、-24.312,P均=0.000)。结论应用LARS人工韧带治疗膝关节多发韧带损伤疗效满意。
Objective To investigate the effect of one-stage arthroscopic reconstruction for multiple ligament injury of knees with Ligament Advanced Reinforcement System( LARS) artificial ligaments. Methods Nineteen patients who suffered from multiple ligament injury of knees( Schenck Ⅲ) were admitted to our hospital from January 2014 to December 2014. All the patients received operation within 6-18 d( mean,11. 6 d). Under arthroscopy,anterior cruciate ligament( ACL) and/or posterior cruciate ligament( PCL) were reconstructed with LARS artificial ligaments simultaneously. Preoperative and postoperative Lysholm function score and Tegner score were used to evaluate effects. Results All the 19 patients were followed up for 22-28 months with an average of 24. 5 months,which showed no infection,ligament rupture,ligament loosening,or other postoperative complications. The Lysholm scores were remarkably increased from 33. 2 ± 2. 3 preoperatively to 85. 6 ± 2. 2 at the latest follow-up,and the Tegner scores were increased from 2. 4 ± 0. 9 preoperatively to 5. 4 ± 1. 1 at the latest follow-up,the difference having statistical significances( t =-22. 422,P =0. 000; t =-24. 312,P = 0. 000). Conclusion Reconstruction of ACL and PCL by LARS artificial ligament is a safe and effective method.
Objective To investigate the effect of one-stage arthroscopic reconstruction for multiple ligament injury of knees with Ligament Advanced Reinforcement System( LARS) artificial ligaments. Methods Nineteen patients who suffered from multiple ligament injury of knees( Schenck Ⅲ) were admitted to our hospital from January 2014 to December 2014. All the patients received operation within 6-18 d( mean,11. 6 d). Under arthroscopy,anterior cruciate ligament( ACL) and/or posterior cruciate ligament( PCL) were reconstructed with LARS artificial ligaments simultaneously. Preoperative and postoperative Lysholm function score and Tegner score were used to evaluate effects. Results All the 19 patients were followed up for 22-28 months with an average of 24. 5 months,which showed no infection,ligament rupture,ligament loosening,or other postoperative complications. The Lysholm scores were remarkably increased from 33. 2 ± 2. 3 preoperatively to 85. 6 ± 2. 2 at the latest follow-up,and the Tegner scores were increased from 2. 4 ± 0. 9 preoperatively to 5. 4 ± 1. 1 at the latest follow-up,the difference having statistical significances( t =-22. 422,P =0. 000; t =-24. 312,P = 0. 000). Conclusion Reconstruction of ACL and PCL by LARS artificial ligament is a safe and effective method.
引文
1 Schenck RC Jr.The dislocated knee.Instr Course Lect,1994,102(43):127-136.
2 Lysholm J,Gillquist J.Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale.Am J Sports Med,1982,10(3):150-154.
3 Tegner Y,Lysholm J.Rating systems in the evaluation of knee ligament injuries.Clin Orthop,1985,(198):43-49.
4 Outerbridge RE.The etiology of chondromalacia patellae.J Bone Joint Surg Br,1961,43-B:752-757.
5 Medina O,Arom GA,Yeranosian MG,et al.Vascular and nerve injury after knee dislocation:a systematic review.Clin Orthop Relat Res,2014,472(9):2621-2629.
6 Khakha RS,Day AC,Gibbs J,et al.Acute surgical management of traumatic knee dislocations:average follow-up of 10 years.Knee,2016,23(2):267-275.
7皇甫小桥,赵金忠,何耀华,等.膝关节多发韧带损伤的修复与重建.中华骨科杂志,2011,31(2):164-168.
8叶俊星,沈光思,周海斌,等.关节镜下使用LARS人工韧带重建膝前、后交叉韧带.中华创伤杂志,2013,29(6):526-531.
9 Trieb K,Blahovec H,Brand G,et al.In vivo and in vitro cellular ingrowth into a new generation of artificial ligaments.Eur Surg Res,2004,36(3):148-151.
10 King AH,Krych AJ,Prince MR,et al.Surgical outcomes of medial versus lateral multiligament injured,dislocated knees.Arthroscopy,2016,32(9):1814-1819.
11李智尧,张磊,刘劲松,等.关节镜下胫骨端Rigid Fix、股骨端Intra Fix固定技术重建后交叉韧带.中国微创外科杂志,2014,14(1):7-11.
12 Bonanzinga T,Zhang H,Song GY,et al.Is PLC repair of a peel-off femoral lesion an effective option in a multiligament setting?Knee Surg Sports Traumatol Arthrosc,2015,23(10):2936-2942.
13吕爱军.膝关节多发韧带损伤早期关节镜下重建与修复.中国矫形外科杂志,2016,24(20):1844-1847.
14 Edson CJ,Fanelli GC,Beck JD.Rehabilitation after multipleligament reconstruction of the knee.Sports Med Arthrosc,2011,19(2):162-166.
15 Gao K,Chen S,Wang L,et al.Anterior cruciate ligament reconstruction with LARS artificial ligament:a multicenter study with 3-to 5-year follow-up.Arthroscopy,2010,26(4):515-523.
16 Batty LM,Norsworthy CJ,Lash NJ,et al.Synthetic devices for reconstructive surgery of the cruciate ligaments:a systematic review.Arthroscopy,2015,31(5):957-968.
17黄建明,刘好源,陈峰嵘,等.LARS人工韧带重建前交叉韧带术后骨隧道变化特点的研究.中华创伤骨科杂志,2013,15(2):123-127.
2 Lysholm J,Gillquist J.Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale.Am J Sports Med,1982,10(3):150-154.
3 Tegner Y,Lysholm J.Rating systems in the evaluation of knee ligament injuries.Clin Orthop,1985,(198):43-49.
4 Outerbridge RE.The etiology of chondromalacia patellae.J Bone Joint Surg Br,1961,43-B:752-757.
5 Medina O,Arom GA,Yeranosian MG,et al.Vascular and nerve injury after knee dislocation:a systematic review.Clin Orthop Relat Res,2014,472(9):2621-2629.
6 Khakha RS,Day AC,Gibbs J,et al.Acute surgical management of traumatic knee dislocations:average follow-up of 10 years.Knee,2016,23(2):267-275.
7皇甫小桥,赵金忠,何耀华,等.膝关节多发韧带损伤的修复与重建.中华骨科杂志,2011,31(2):164-168.
8叶俊星,沈光思,周海斌,等.关节镜下使用LARS人工韧带重建膝前、后交叉韧带.中华创伤杂志,2013,29(6):526-531.
9 Trieb K,Blahovec H,Brand G,et al.In vivo and in vitro cellular ingrowth into a new generation of artificial ligaments.Eur Surg Res,2004,36(3):148-151.
10 King AH,Krych AJ,Prince MR,et al.Surgical outcomes of medial versus lateral multiligament injured,dislocated knees.Arthroscopy,2016,32(9):1814-1819.
11李智尧,张磊,刘劲松,等.关节镜下胫骨端Rigid Fix、股骨端Intra Fix固定技术重建后交叉韧带.中国微创外科杂志,2014,14(1):7-11.
12 Bonanzinga T,Zhang H,Song GY,et al.Is PLC repair of a peel-off femoral lesion an effective option in a multiligament setting?Knee Surg Sports Traumatol Arthrosc,2015,23(10):2936-2942.
13吕爱军.膝关节多发韧带损伤早期关节镜下重建与修复.中国矫形外科杂志,2016,24(20):1844-1847.
14 Edson CJ,Fanelli GC,Beck JD.Rehabilitation after multipleligament reconstruction of the knee.Sports Med Arthrosc,2011,19(2):162-166.
15 Gao K,Chen S,Wang L,et al.Anterior cruciate ligament reconstruction with LARS artificial ligament:a multicenter study with 3-to 5-year follow-up.Arthroscopy,2010,26(4):515-523.
16 Batty LM,Norsworthy CJ,Lash NJ,et al.Synthetic devices for reconstructive surgery of the cruciate ligaments:a systematic review.Arthroscopy,2015,31(5):957-968.
17黄建明,刘好源,陈峰嵘,等.LARS人工韧带重建前交叉韧带术后骨隧道变化特点的研究.中华创伤骨科杂志,2013,15(2):123-127.