微创手术治疗O'Donoghue三联征30例临床体会
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摘要
目的探讨早期微创手术对O'Donoghue三联征(前交叉韧带断裂合并内侧副韧带断裂和内侧半月板损伤)的治疗效果。方法回顾性分析2009年12月—2014年1月收治的30例膝关节三联损伤患者,进行关节镜下重建前交叉韧带断裂、内侧半月板损伤修复成形、内侧副韧带断裂带线锚钉固定或可吸收线缝合。术后6个月后对膝关节功能应用Lysholm评分和Tegner评分进行评估,并对其手术时间、术后引流量以及随访12个月内患者的恢复情况进行统计学分析。结果 30例患者的平均手术时间为(1.8±1.3)h,术后引流量为(205±11.8)ml,除1例患者因卧床问题出现患部麻木胀痛以外,其余均保持较好的临床情况。全部病例均获随访,随访6个月后,临床总有效率达93.3%(28/30),其中优24例(80.0%),好转4例(13.3%),无效2例(6.7%);关节稳定性良好,膝关节屈曲超过120°者28例(93.3%),2例因术后惧怕疼痛导致膝关节屈曲练习角度不足120°;术后遗留膝关节活动时疼痛2例。术后12个月后,30例患者均可进行正常的膝伸屈,且可通过膝伸屈以及外翻应力试验(0°和30°)检测。对膝关节功能进行Lysholm和Tegner评分,与术前比较差异均有统计学意义(t=12.213、15.322,12.267、13.322,P<0.01)。结论对膝关节三联伤进行早期的微创手术治疗,不仅可以将创伤降到最小,还可以在处理合并损伤的同时,恢复膝关节的稳定性和功能。
Objective To investigate the effect of early minimally invasive surgery on O Donoghue(anterior cruciate ligament rupture and medial collateral ligament rupture and medial meniscus).Methods Retrospectively analyzed the data of30 knee joint triple damage cases irom December 2009 to January 2014,reconstruction of the anterior cruciate ligament rupture,medial meniscus repair forming,medial collateral ligament rupture suture anchors fixation or absorbable suture arthroscopic were performed.6 months later,Lysholm score and Tegner score were used to evaluate the function of knee joint,and analyzed the restoration of the operation time,postoperative drainage during 12 months of Follow-up.Results The average operation time of these 30 patients was(1.8 ± 1.3) h,postoperative drainage was(205.0 ± 11.8) ml,except 1 patient had affected part numbness pain due to lying bed problems,the rest were maintained in good clinical condition.All the patients were followed up,for 6 months,the clinical total effective rate was 93.3%(28/30),24 cases of excellent(80.0%),improved in 4 cases(13.3%),invalid in 2 cases(6.7%);the joint stability was good,28 cases with more than 120 degrees of knee flexion(93.3%),2 cases' postoperative knee flexion angle less than 120 degrees due to fear the pain;postoperative left knee pain during activity in 2 cases.After follow up of 12 months,30 patients with normal knee flexion,knee extension and flexion and the valgus stress test(0°and 30°) were all passed.Compared with the preoperative,Lysholm and Tegner score of knee joint function were improved with statistics significance differences(t=12.213,t=15.322,t=12.267,t=13.322,P <0.01).Conclusion Early minimally invasive surgical treatment for knee joint triple injury not only can reduce the trauma to a minimum level,but also help to stablility and recovery the function of knee joint in processing of repairing the trauma.
Objective To investigate the effect of early minimally invasive surgery on O Donoghue(anterior cruciate ligament rupture and medial collateral ligament rupture and medial meniscus).Methods Retrospectively analyzed the data of30 knee joint triple damage cases irom December 2009 to January 2014,reconstruction of the anterior cruciate ligament rupture,medial meniscus repair forming,medial collateral ligament rupture suture anchors fixation or absorbable suture arthroscopic were performed.6 months later,Lysholm score and Tegner score were used to evaluate the function of knee joint,and analyzed the restoration of the operation time,postoperative drainage during 12 months of Follow-up.Results The average operation time of these 30 patients was(1.8 ± 1.3) h,postoperative drainage was(205.0 ± 11.8) ml,except 1 patient had affected part numbness pain due to lying bed problems,the rest were maintained in good clinical condition.All the patients were followed up,for 6 months,the clinical total effective rate was 93.3%(28/30),24 cases of excellent(80.0%),improved in 4 cases(13.3%),invalid in 2 cases(6.7%);the joint stability was good,28 cases with more than 120 degrees of knee flexion(93.3%),2 cases' postoperative knee flexion angle less than 120 degrees due to fear the pain;postoperative left knee pain during activity in 2 cases.After follow up of 12 months,30 patients with normal knee flexion,knee extension and flexion and the valgus stress test(0°and 30°) were all passed.Compared with the preoperative,Lysholm and Tegner score of knee joint function were improved with statistics significance differences(t=12.213,t=15.322,t=12.267,t=13.322,P <0.01).Conclusion Early minimally invasive surgical treatment for knee joint triple injury not only can reduce the trauma to a minimum level,but also help to stablility and recovery the function of knee joint in processing of repairing the trauma.
引文
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2 DeMaria M,Barbiera F,Lo Casto A,et al.Biomechanical correlations of lesions associated with traumatic diseases of the anterior cruciate ligament[J].Radiol Med,1996,91(6):693-699.
3 Fanelli GC,Tomaszewski DJ.Allograft use in the treatment of the multiple ligament injured knee[J],Sports Med Arthrose,2007,15:139-148.
4李森田,臧建成,张达夫.关节镜下早期修复重建治疗急性膝关节三联损伤[J].中国微创外科杂志,2010,10(9):777-778.
5孙百胜,郑雷,纪丙军,等.膝关节韧带损伤及伴发半月板损伤的MRI分析[J/CD].中华临床医师杂志:电子版,2013,14(14):6322-6328.
6杨渝平,敖英芳,王健,等.急性前交叉韧带断裂合并内侧副韧带、半月板损伤的临床研究[J].中国运动医学杂志,2007,26(5):527-529.
7罗浩,敖英芳,彭立彬,等.膝关节前交叉韧带重建术取腱切口方向与隐神经髌下支损伤关系探讨[J].中国运动医学杂志,2006,25(3):294-296.
8蔡海康,张银网,解品亮,等.关节镜辅助下锁定加压钢板微创治疗胫骨平台SchalzkerⅠ,Ⅱ,Ⅲ型骨折[J].现代预防医学,2011,38(10):1965-1967.
9左立新,高雁卿,杨卫兵,等.腓骨长肌腱移植后对足弓的影响[J].中国矫形外科杂志,2009,17(15):1198-1199.
10汤志宏,王兵,胡闯,等.患侧胴绳肌腱移植重建膝关节前交叉韧带治疗膝关节三联征[J].临床军医杂志,2013,41(6):638-639.
11于长隆,敖英芳.中华骨科学—运动创伤卷[M].北京:人民卫生出版社,2010:154.
12史福东,左金增,刘仕杰,等.腓骨长肌腱重建前交叉韧带结合一期锚钉修复严重内侧副韧带损伤的早期疗效[J].中国骨与关节杂志,2014,3(1):38-44.
13汤秋贤.关节镜微创手术治疗膝关节痛风性关节炎1例分析[J].实用中西医结合临床,2014,14(1):49-50.
14黄珍谷,王棚,陈兴华,等.关节镜下手术治疗半月板损伤42例疗效观察[J].河北中医,2014,36(11):1754-1756.
15庄伟雄,郝敬军,文海忠,等.低场MRI对膝关节外伤的临床诊治研究[J].中国医药导报,2007,4(34):149-151.
16刘书田,杨志飞,陈雪华.多层螺旋CT多平面和三维重组在膝关节骨折中的临床应用价值[J].中国医药,2010,5(6):548-549.
17柳东旭,姚建华,孙天胜,等.急性前交叉韧带损伤合并内侧副韧带损伤治疗后的康复训练[J].中国医药导报,2013,10(18):66-68,71.
2 DeMaria M,Barbiera F,Lo Casto A,et al.Biomechanical correlations of lesions associated with traumatic diseases of the anterior cruciate ligament[J].Radiol Med,1996,91(6):693-699.
3 Fanelli GC,Tomaszewski DJ.Allograft use in the treatment of the multiple ligament injured knee[J],Sports Med Arthrose,2007,15:139-148.
4李森田,臧建成,张达夫.关节镜下早期修复重建治疗急性膝关节三联损伤[J].中国微创外科杂志,2010,10(9):777-778.
5孙百胜,郑雷,纪丙军,等.膝关节韧带损伤及伴发半月板损伤的MRI分析[J/CD].中华临床医师杂志:电子版,2013,14(14):6322-6328.
6杨渝平,敖英芳,王健,等.急性前交叉韧带断裂合并内侧副韧带、半月板损伤的临床研究[J].中国运动医学杂志,2007,26(5):527-529.
7罗浩,敖英芳,彭立彬,等.膝关节前交叉韧带重建术取腱切口方向与隐神经髌下支损伤关系探讨[J].中国运动医学杂志,2006,25(3):294-296.
8蔡海康,张银网,解品亮,等.关节镜辅助下锁定加压钢板微创治疗胫骨平台SchalzkerⅠ,Ⅱ,Ⅲ型骨折[J].现代预防医学,2011,38(10):1965-1967.
9左立新,高雁卿,杨卫兵,等.腓骨长肌腱移植后对足弓的影响[J].中国矫形外科杂志,2009,17(15):1198-1199.
10汤志宏,王兵,胡闯,等.患侧胴绳肌腱移植重建膝关节前交叉韧带治疗膝关节三联征[J].临床军医杂志,2013,41(6):638-639.
11于长隆,敖英芳.中华骨科学—运动创伤卷[M].北京:人民卫生出版社,2010:154.
12史福东,左金增,刘仕杰,等.腓骨长肌腱重建前交叉韧带结合一期锚钉修复严重内侧副韧带损伤的早期疗效[J].中国骨与关节杂志,2014,3(1):38-44.
13汤秋贤.关节镜微创手术治疗膝关节痛风性关节炎1例分析[J].实用中西医结合临床,2014,14(1):49-50.
14黄珍谷,王棚,陈兴华,等.关节镜下手术治疗半月板损伤42例疗效观察[J].河北中医,2014,36(11):1754-1756.
15庄伟雄,郝敬军,文海忠,等.低场MRI对膝关节外伤的临床诊治研究[J].中国医药导报,2007,4(34):149-151.
16刘书田,杨志飞,陈雪华.多层螺旋CT多平面和三维重组在膝关节骨折中的临床应用价值[J].中国医药,2010,5(6):548-549.
17柳东旭,姚建华,孙天胜,等.急性前交叉韧带损伤合并内侧副韧带损伤治疗后的康复训练[J].中国医药导报,2013,10(18):66-68,71.