自体腘绳肌腱同时重建膝关节后交叉韧带和后外侧复合体
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摘要
目的观察应用自体腘绳肌腱重建膝关节后交叉韧带合并后外侧复合体损伤的效果。方法回顾性分析2015年1月～2017年1月我科收治的经关节镜证实为膝关节后交叉韧带断裂, MRI和临床检查确诊为后外侧复合体损伤松弛的31例患者的临床资料,均采用自体双股腘绳肌腱重建后交叉韧带,股骨端应用Endobutton系统,胫骨端应用挤压螺钉固定,同时取另一侧腘绳肌腱重建后外侧复合体,股骨和胫骨端均用挤压螺钉固定。结果本组患者术后切口均Ⅰ期愈合,无感染病例。31例患者均获随访,平均14(12～24)月,未发现稳定性丢失病例。重建前行后抽屉试验示:2+6例, 3+10例, 4+15例,均合并外旋位后向不稳定;重建后行后抽屉试验结果示:阴性21例, 1+6例, 2+4例,外旋位后向均稳定,较手术前改善明显(P<0.05)。膝关节伸直和屈曲30°位内翻试验均为阴性。术后3、 6、 12月膝关节Lysholm功能评分分别为(78.7±4.8)分、(89.1±3.7)分和(97.2±1.5)分,均较重建前(69.5±5.6)明显提高(t=6.438,t=7.562,t=5.389,P均<0.05)。结论关节镜辅助下应用自体腘绳肌腱重建膝关节后交叉韧带合并后外侧复合体损伤是一种有效纠正膝关节后向后外向、不稳定的方法,术后膝关节功能改善明显,重建效果满意。
Objective To investigate the clinical effect of the reconstruction of the injuries of posterior cruciate ligament(PCL) and posterolateral complex(PLC) of knee joint with autologous hamstring tendon.Methods A total of 31 patients with PCL combined with PLC injuries of the knee joint confirmed by arthroscopy and MRI were analyzed retrospectively. The double autograft hamstring tendon was used to reconstruct the PCL, and the Endobutton system and compression screw were applied to fix the femoral end and tibial end respectively. The other lateral hamstring tendon was used to reconstruct the PLC and the compression screw was applied to fix the femoral and tibial end. Results All incisions healed in stage Ⅰ without infection. No stability loss was found during 12 to 24 months follow-up with an average of 14 months. The drawer test results showed that 6 cases of 2+, 10 cases of 3+ and 15 cases of 4+ as well as backward instability of external rotation in all cases before the reconstruction, and 21 of negative, 6 of 1+ and 4 of 2+ and backward stability in all cases after the reconstruction. There were statistical differences between before and after the operation(P<0.05). All knee joint extension and flexion tests were negative at 30°. The Lysholm scores were 78.7±4.8, 89.1±3.7 and 97.2±1.5 at 3-, 6-and 12 months after the surgery respectively, which were increased remarkably
Objective To investigate the clinical effect of the reconstruction of the injuries of posterior cruciate ligament(PCL) and posterolateral complex(PLC) of knee joint with autologous hamstring tendon.Methods A total of 31 patients with PCL combined with PLC injuries of the knee joint confirmed by arthroscopy and MRI were analyzed retrospectively. The double autograft hamstring tendon was used to reconstruct the PCL, and the Endobutton system and compression screw were applied to fix the femoral end and tibial end respectively. The other lateral hamstring tendon was used to reconstruct the PLC and the compression screw was applied to fix the femoral and tibial end. Results All incisions healed in stage Ⅰ without infection. No stability loss was found during 12 to 24 months follow-up with an average of 14 months. The drawer test results showed that 6 cases of 2+, 10 cases of 3+ and 15 cases of 4+ as well as backward instability of external rotation in all cases before the reconstruction, and 21 of negative, 6 of 1+ and 4 of 2+ and backward stability in all cases after the reconstruction. There were statistical differences between before and after the operation(P<0.05). All knee joint extension and flexion tests were negative at 30°. The Lysholm scores were 78.7±4.8, 89.1±3.7 and 97.2±1.5 at 3-, 6-and 12 months after the surgery respectively, which were increased remarkably
引文
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[11] 李前,陈绍军,李岗,徐昭乐.“8”字悬吊法重建外侧副韧带及腘腓韧带治疗膝关节多发韧带损伤[J].中医正骨,2017,29(3):49-51.
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[13] 谭海涛,江建中,杨克勤,等.关节镜引导下锚钉缝线治疗后交叉韧带胫骨止点骨折[J].微创医学,2010,5(1):8-10.
[14] 白晓东,王耀霆,车琦,等.膝关节镜全内技术自体胭绳肌腱移植一期重建前、后十字韧带断裂[J].中华骨科杂志,2018,38(17):1045-1054.
[15] Woodmass JM,Johnson NR,Mohan R,et al.Poly-traumatic multi-ligament knee injuries:is the knee the limiting factor?[J].Knee Surg Sports Traumatol Arthrosc,2018,26(9):2865-2871.doi:10.1007/s00167-017-4784-3.
[16] Buyukdogan K,Laidlaw MS,Miller MD.Surgical management of the multiple-ligament knee injury[J].Arthrosc Tech,2018,7(2):e147-e164.doi:10.1016/j.eats.2017.08.079.eCollection 2018 Feb.
[17] Sun L,Wu B,Tian M,et al.Results of multiple ligament injured knees operated by three different strategies[J].Indian J Orthop,2016,50(1):43-48.doi:10.4103/0019-5413.173504.
[18] Li S,Chen Y,Lin Z,et al.A systematic review of randomized controlled clinical trials comparing hamstring autografts versus bone-patellar tendon-bone autografts for the reconstruction of the anterior cruciate ligament[J].Arch Orthop Trauma Surg,2012,132(9):1287-1297.doi:10.1007/s00402-012-1532-5.
[19] Gifstad T,Foss OA,Engebretsen L,et al.Lower risk of revision with patellar tendon autografts compared with hamstring autografts:a registry study based on 45,998 primary ACL reconstructions in Scandinavia[J].Am J Sports Med,2014,42(10):2319-2328.doi:10.1177/0363546514548164.Epub 2014 Sep 8.
[20] Krych AJ,Sousa PL,King AH,et al.Meniscal tears and articular cartilage damage in the dislocated knee[J].Knee Surg Sports Traumatol Arthrosc,2015,23(10):3019-3025.doi:10.1007/s00167-015-3540-9.
[21] Stannard JP,Bauer KL.Current concepts in knee dislocations:PCL,ACL,and medial sided injuries[J].J Knee Surg,2012,25(4):287-294.
[22] Darabos N,Gusic N,Vlahovic T,et al.Staged management of knee dislocation in polytrauma injured patients[J].Injury,2013,44 Suppl 3:S40-45.doi:10.1016/S0020-1383(13)70196-7.
[23] Rosas HG.Unraveling the posterolateral corner of the knee[J].Radiographics,2016,36(6):1776-1791.
[2] Stannard JP,Brown SL,Robinson JT,et al.Reconstruction of the posterolateral corner of the knee[J].Arthroscopy,2005,21(9):1051-1059.
[3] 胡毅.膝关节镜下治疗27例膝关节后外侧结构损伤临床分析[J].深圳中西医结合杂志,2017,27(12):142-143.
[4] Chahla J,Moatshe G,Dean CS,et al.Posterolateral corner of the knee:current concepts[J].Arch Bone Jt Surg,2016,4(2):97-103.
[5] Takahashi H,Tajima G,Kikuchi S,et al.Morphology of the fibular insertion of the posterolateral corner and biceps femoris tendon[J].Knee Surg Sports Traumatol Arthrosc,2017,25(1):184-191.doi:10.1007/s00167-016-4304-x.
[6] 肖宇,王兆杰,安荣泽.膝关节后外侧复合体重建术的研究进展[J].吉林医学,2014,35(10):2198-2199.
[7] Sekiya JK,West RV,Ong BC,et al.Clinical outcomes after isolated arthroscopic single-bundle posterior cruciate ligament reconstruction[J].Arthroscopy,2005,21(9):1042-1050.
[8] Kennedy N1,LaPrade CM,LaPrade RF.Surgical management and treatment of the anterior cruciate ligament/posterolateral corner injured knee[J].Clin Sports Med,2017,36(1):105-117.doi:10.1016/j.csm.2016.08.011.
[9] 陈鸿,鲁宁,张颖.膝关节后交叉韧带合并后外侧角结构损伤的联合重建[J].中华创伤骨科杂志,2008,10(3):229-233.
[10] An W,Qiu S,Zhu T,et al.Comparative study on the treatment of acromioclavicular joint dislocation:coracoclavicular ligament reconstruction using lateral half of conjoined tendon or tractusiliotibialis with hook plate fixation[J].Zhonghua Yi Xue Za Zhi,2015,95(5):363-367.
[11] 李前,陈绍军,李岗,徐昭乐.“8”字悬吊法重建外侧副韧带及腘腓韧带治疗膝关节多发韧带损伤[J].中医正骨,2017,29(3):49-51.
[12] Mousavi H,Maleki A,Nobakht A.Comparative study after hamstring anterior cruciate ligament reconstruction with endobutton and rigidfix:A clinical trial study[J].Adv Biomed Res,2017,6:136.doi:10.4103/2277-9175.218027.eCollection 2017.
[13] 谭海涛,江建中,杨克勤,等.关节镜引导下锚钉缝线治疗后交叉韧带胫骨止点骨折[J].微创医学,2010,5(1):8-10.
[14] 白晓东,王耀霆,车琦,等.膝关节镜全内技术自体胭绳肌腱移植一期重建前、后十字韧带断裂[J].中华骨科杂志,2018,38(17):1045-1054.
[15] Woodmass JM,Johnson NR,Mohan R,et al.Poly-traumatic multi-ligament knee injuries:is the knee the limiting factor?[J].Knee Surg Sports Traumatol Arthrosc,2018,26(9):2865-2871.doi:10.1007/s00167-017-4784-3.
[16] Buyukdogan K,Laidlaw MS,Miller MD.Surgical management of the multiple-ligament knee injury[J].Arthrosc Tech,2018,7(2):e147-e164.doi:10.1016/j.eats.2017.08.079.eCollection 2018 Feb.
[17] Sun L,Wu B,Tian M,et al.Results of multiple ligament injured knees operated by three different strategies[J].Indian J Orthop,2016,50(1):43-48.doi:10.4103/0019-5413.173504.
[18] Li S,Chen Y,Lin Z,et al.A systematic review of randomized controlled clinical trials comparing hamstring autografts versus bone-patellar tendon-bone autografts for the reconstruction of the anterior cruciate ligament[J].Arch Orthop Trauma Surg,2012,132(9):1287-1297.doi:10.1007/s00402-012-1532-5.
[19] Gifstad T,Foss OA,Engebretsen L,et al.Lower risk of revision with patellar tendon autografts compared with hamstring autografts:a registry study based on 45,998 primary ACL reconstructions in Scandinavia[J].Am J Sports Med,2014,42(10):2319-2328.doi:10.1177/0363546514548164.Epub 2014 Sep 8.
[20] Krych AJ,Sousa PL,King AH,et al.Meniscal tears and articular cartilage damage in the dislocated knee[J].Knee Surg Sports Traumatol Arthrosc,2015,23(10):3019-3025.doi:10.1007/s00167-015-3540-9.
[21] Stannard JP,Bauer KL.Current concepts in knee dislocations:PCL,ACL,and medial sided injuries[J].J Knee Surg,2012,25(4):287-294.
[22] Darabos N,Gusic N,Vlahovic T,et al.Staged management of knee dislocation in polytrauma injured patients[J].Injury,2013,44 Suppl 3:S40-45.doi:10.1016/S0020-1383(13)70196-7.
[23] Rosas HG.Unraveling the posterolateral corner of the knee[J].Radiographics,2016,36(6):1776-1791.