[1]王培召 王啸 史小涛 韩旭 于进洋 袁彦浩 谭红略△.关节镜下一期治疗膝关节多发韧带损伤35例[J].中国中医骨伤科杂志,2021,29(06):78-82.
　WANG Peizhao WANG Xiao SHI Xiaotao HAN XuYU Jinyang YUAN Yanhao TAN Honglue.One-Stage Arthroscopic Treatment for 35 Cases ofMultiple Ligament Injuries of the Knee Joint[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2021,29(06):78-82.
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关节镜下一期治疗膝关节多发韧带损伤35例()
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《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第29卷
期数:
2021年06期
页码:
78-82
栏目:
临床报道
出版日期:
2021-06-15

文章信息/Info

Title:
One-Stage Arthroscopic Treatment for 35 Cases ofMultiple Ligament Injuries of the Knee Joint
文章编号:
1005-0205(2021)06-0078-05
作者:
王培召1; 2 王啸2 史小涛2 韩旭2 于进洋2 袁彦浩2 谭红略2△
1河南中医药大学(郑州,450046)2河南省洛阳正骨医院(河南省骨科医院)
Author(s):
WANG Peizhao1; 2 WANG Xiao2 SHI Xiaotao2 HAN Xu2YU Jinyang2 YUAN Yanhao2 TAN Honglue2△
1Henan University of Chinese Traditional Medicine,Zhengzhou 450046, China; 2Henan Luoyang Orthopedic-Traumatological Hospital(Henan Orthopedic Hospital),Luoyang 470002, Henan China.
关键词:
膝关节;  多发韧带损伤;  TightRope钢板;  自体肌腱;  关节镜
Keywords:
knee joint;  multiple ligament injuries;  TightRope suspension plate;  autologous;  arthroscopy
分类号:
R686.5
文献标志码:
B
摘要:
目的:探讨关节镜下一期修复重建膝关节多发韧带损伤的疗效。方法:2014年8月至2018年12月,对35例膝关节多发韧带损伤患者,采用关节镜下自体腘绳肌腱结合TightRope钢板重建前后交叉韧带,联合有限切开修复重建后内侧角或后外侧角,同时处理合并伤。随访期间,通过关节稳定性检查、Lysholm评分及国际膝关节文献委员会(IKDC)膝关节主观评分对患者膝关节功能进行评价。结果:35例患者术后均获得随访,随访时间12～48个月,平均26.1个月。术中发生腘动脉外侧壁损伤1例,术中予以修补; 合并半月板损伤10例,予以半月板成形术或缝合修复术; 1例腓总神经损伤患者术中探查其神经连续性完整。术后1例外侧切口愈合不良,清创后愈合; 其他患者均Ⅰ期愈合。末次随访,患者膝关节Lysholm评分及IKDC评分与术前比较改善明显,差异均有统计学意义(P<0.05)。结论:关节镜下一期修复重建膝关节多发韧带损伤,具有微创便捷、固定牢固、住院周期短等优点,可较好恢复膝关节的稳定性及功能。
Abstract:
To investigate the clinical efficacy of one-stage arthroscopic repair and reconstruction for multiple ligament injuries of the knee joint.Methods:From August 2014 to December 2018, 35 patients with multiple ligament injuries of the knee joint were treated.Anterior cruciate ligament(ACL)and posterior cruciate ligament(PCL)were reconstructed by autologous hamstring tendons combined with TightRope suspension plates under an arthroscopy. Limited incision was performed to reconstruct medial and posterior lateral part of cartilage injury. Meanwhile, the associated injuries were treated. During the follow-up period, the joint stability examination, Lysholm score and IKDC knee subjective score were used for knee functional evaluation.Results:All 35 patients were successfully followed up after the operation for 12 to 48 months, with an average of 26.1 months. Intraoperative popliteal artery lateral wall injury occurred in 1 case, which was intraoperatively repaired. Meniscus injury was combined in 10 cases, and meniscus plasty or suture repair were performed. The nerve continuity of 1 patient with common peroneal nerve injury was investigated to be complete during the operation. One of the side incisions healed poorly after operation, and the wound healed after debridement. The other patients were healed by first intention. At the last follow-up, the knee Lysholm score and IKDC score were obviously improved compared with those before surgery, and the differences were statistically significant(P<0.05).Conclusion:One-stage arthroscopic repair and reconstruction for multiple ligament injuries of the knee joint has the advantages of minimally invasive and convenient, solid fixation, and short hospitalization period. It can better restore the stability and function of the knee joint.

参考文献/References:


[1] WILSON S M, MEHTA N, DO H T,et al.Epidemiology of multiligament knee reconstruction[J].Clin Orthop Relat Res,2014,472(9):2603-2608.
[2] 杨帆,贾庆卫.膝关节多韧带损伤诊疗现状[J].中国矫形外科杂志,2013,21(10):984-988.
[3] SKENDZEL J G, SEKIYA J K, WOJTYS E M.Diagnosis and management of the multiligament-injured knee[J].J Orthop Sports Phys Ther,2012,42(3):234-242.
[4] HANLEY J, WESTERMANN R, COOK S,et al.Factors associated with knee stiffness following surgical management of multiligament knee injuries[J].The Journal of Knee Surgery,2017,30(6):549-554.
[5] 代朋乙,黄昌林.关节镜下一期修复重建膝关节多发韧带损伤的疗效观察[J].解放军医学杂志,2019,44(1):57-62.
[6] PESKUN C J, WHELAN D B.Outcomes of operative and nonoperative treatment of multiligament knee injuries:an evidence-based review[J].Sports Med Arthrosc,2011,19(2):167-173.
[7] MURAKAMI R, HONDA E, FUKAI A,et al.Single-stage arthroscopic anterior and posterior cruciate ligament repairs and open medial collateral ligament repair for acute knee dislocation[J].Case Rep Orthop,2020:7348201.
[8] 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[J].中华骨科杂志,2011,31(2):164-168.
[9] SCHILLHAMMER C K, REID J B, RISTER J,et al.Arthroscopy up to date:anterior cruciate ligament anatomy[J].Arthroscopy,2016,32(1):209-212.
[10] ANDERSON C J, ZIEGLER C G, WIJDICKS C A,et al.Arthroscopically pertinent anatomy of the anterolateral and posteromedial bundles of the posterior cr uciate ligament[J].J Bone Joint Surg Am,2012,94(21):1936-1945.
[11] ZHANG H, SUN Y, HAN X,et al.Simultaneous reconstruction of the anterior cruciate ligament and medial collateral ligament in patie nts with chronic ACL-MCL lesions:a minimum 2-year follow-up study[J].Am J Sports Med,2014,42(7):1675-1681.
[12] PETRIGLIANO F A, LANE C G, SUERO E M,et al.Posterior cruciate ligament and posterolateral corner deficiency results in a reverse pivot shift[J].Clin Orthop Relat Res,2012,470(3):815-823.
[13] SUBBIAH M, PANDEY V, RAO S K,et al.Staged arthroscopic reconstructive surgery for multiple ligament injuries of the knee[J].J Orthop Surg(Hong Kong),2011,19(3):297-302.
[14] 毕海勇,孙秀江,慕宏杰,等.膝关节脱位早期与延期手术疗效分析[J].中华损伤与修复杂志(电子版),2010,5(5):629-636.
[15] 毛云鹤,唐婕晞,李箭,等.膝关节多发韧带损伤不同手术时机与疗效相关性的Meta分析[J].中国循证医学杂志,2019,19(4):418-423.
[16] VERMEIJDEN H D, JONKERGOUW A, VAN DER LIST J P,et al.The multiple ligament-injured knee:when is primary repair an option?[J].Knee,2020,27(1):173-182.
[17] 史文骥,任强,毛宾尧.膝关节多发韧带伤关节镜下同期重建的疗效分析[J].中国内镜杂志,2019,25(7):17-21.
[18] 谭红略,代朋乙,袁延浩.关节镜下单束六股自体腘绳肌腱联合TightRope钢板解剖重建前交叉韧带的近期疗效[J].中国修复重建外科杂志,2016,30(6):695-699.
[19] CONNER C S, PEREZ B A, MORRIS R P,et al.Three femoral fixation devices for anterior cruciate ligament reconstruction:comparison of fixation on the lateral cortex versus the anterior cortex[J].Arthroscopy,2010,26(6):796-807.
[20] 毛云鹤,唐婕晞,李箭,等.穿骨原位缝合修复前交叉韧带技术在膝关节多发韧带损伤脱位中的应用[J].中国修复重建外科杂志,2020,34(2):190-195.
[21] EDSON C J, FANELLI G C, BECK J D.Rehabilitation after multiple-ligament reconstruction of the knee[J].Sports Med Arthrosc,2011,19(2):162-166.

备注/Memo

备注/Memo:
△通信作者 E-mail:hnlc.love@163.com
更新日期/Last Update: 2021-06-15