膝关节多发韧带损伤中后外侧复合体的解剖重建_张东亮

膝关节多发韧带损伤中后外侧复合体的解剖重建

张东亮王磊曹建刚刘军

【摘 要】目的探讨膝关节多发韧带损伤中后外侧复合体（posterolateral complex，PLC）解剖重建的方法及近期疗效。方法 2007年6月－2011年7月，收治23例膝关节多发韧带损伤患者。男15例，女8例；年龄19～56岁，平均41岁。交通事故伤9例，扭伤7例，砸伤3例，高处坠落伤4例。损伤至手术时间13～78 d，平均32 d。患者后抽屉试验及Lachman试验均呈阳性，均伴内翻、外旋不稳。膝关节Lysholm评分为（43.4 ± 5.7）分。国际膝关节文献委员会（IKDC）综合评分均为D级。PLC损伤根据Fanelli分型标准，均为C型。X线片检查示，后方应力下胫骨后移（13.3 ± 4.2）mm，内翻应力下外侧关节间隙张开（15.1 ± 2.4）mm。术中取自体同侧/对侧半腱肌、股薄肌肌腱，必要时联合同种异体肌腱，关节镜下重建前、后交叉韧带，并联合后外侧切口行PLC静力性解剖重建。结果术后切口均Ⅰ期愈合，无相关并发症发生。患者均获随访，随访时间12～56个月，平均28个月。末次随访时，患者后抽屉试验及Lachman试验均呈阴性， 3例内翻不稳，2例外旋不稳。膝关节Lysholm评分为（85.6 ± 16.7）分，与术前比较差异有统计学意义（t=11.469，P=0.000）。IKDC综合评分：A级7例，B级12例，C级4例；与术前比较差异有统计学意义（Z=4.285，P=0.000）。X线片检查示，后方应力下胫骨后移（5.1 ± 4.4）mm，内翻应力下外侧关节间隙张开（3.2 ± 2.8）mm，与术前比较差异均有统计学意义（P < 0.05）。结论在膝关节多发韧带损伤的治疗中，应用自体腘绳肌肌腱，必要时联合同种异体肌腱解剖重建PLC，可获得较好近期疗效。

【关键词】膝关节后外侧复合体多发韧带损伤解剖重建

ANATOMICAL RECONSTRUCTION OF POSTEROLATERAL COMPLEX IN TREATMENT OF MULTI-LIGAMENT INJURY OF KNEES/ZHANG Dongliang, WANG Lei, CAO Jiangang, LIU Jun. Department of Joint Surgery, Tianjin Union Medical Center, Nankai University People’s Hospital, Tianjin, 300121, P.R.China. Corresponding author: LIU Jun, E-mail: drliujun@

【Abstract】Objective To evaluate the short-term eff ectiveness after static anatomical reconstruction of posterolateral complex (PLC) in the treatment of traumatic multi-ligament injury of the knee. Methods Between June 2007 and July 2011, 23 cases of multi-ligament injury of the knee were treated. There were 15 males and 8 females with an average age of 41 years (range, 19-56 years). The injury was caused by traffi c accident in 9 cases, sprain in 7 cases, bruise in 3 cases, and falling from height in 4 cases. The time between injury and operation was 13-78 days (mean, 32 days). The results of posterior drawer test and Lachman test were positive, and all cases complicated by varus and external rotation instability. The Lysholm score of the knee was 43.4 ± 5.7. According to International Knee Documentation Committee (IKDC) scoring, all were rated as grade D. According to Fanelli typing, all were classifi ed as type C. The X-ray fi lms showed that load-induced posterior motion of the knee was (13.3 ± 4.2) mm; the lateral joint space was (15.1 ± 2.4) mm. Anterior cruciate ligament/posterior cruciate ligament and PLC were reconstructed simultaneously with auto-semitendinosus, gracilis tendon, and allogeneic tendon. Results All incisions healed by fi rst intention, and no complication occurred. All patients were followed up 12-56 months (mean, 28 months). At last follow-up, the results of posterior drawer test and Lachman test were negative; 3 cases had varus instability, and 2 cases had external rotation instability. The Lysholm score of the knee was 85.6 ± 16.7, showing signifi cant diff erence when compared with preoperative score (t=11.469, P=0.000). According to IKDC scoring, 7 cases were rated as grade A, 12 as grade B, and 4 as grade C; signifi cant diff erence was found when compared with preoperative value (Z=4.285, P=0.000). The load-induced posterior motion of the knee was (5.1 ± 4.4) mm, the lateral joint space was (3.2 ± 2.8) mm, showing signifi cant diff erences when compared with preoperative ones (P < 0.05). Conclusion In the treatment of traumatic multi-ligament injury of the knee, the anatomical reconstruction of the PLC using auto-semitendinosus, gracilis tendon, or allogeneic tendon can obtain good short-term eff ectiveness.

【Key words】 Knee joint Posterolateral complex Multi-ligament injury Anatomical reconstruction

DOI：10.7507/1002-1892.20130101

作者单位：天津市人民医院暨南开大学人民医院关节外科（天津，300121）

通讯作者：刘军，副主任医师，硕士生导师，研究方向：运动医学、关节置换，E-mail: drliujun@

网络出版时间：2013-3-18 17:26:58；网络出版地址：/kcms/detail/51.1372.R.20130318.1726.012.html