【摘要】 目的探讨膝关节多韧带损伤的临床特点,并评估其治疗效果。方法9例患者(9膝)经临床及关节镜检查证实前交叉韧带(ACL)和后交叉韧带(PCL)均断裂,其中5膝伴后内侧角(PMC)、内侧副韧带损伤(MCL),急性期4膝伴后外侧角损伤(PLC)。4膝行膝后内侧角、内侧副韧带修复。9例患者于伤后4~10周在关节镜下行自体移植物单束ACL和PCL联合重建术,其中4例同期后1/2股二头肌肌腱重建后PLC,1例同期阔筋膜PMC、MCL重建。结果术后随访10~39个月,平均(23·0±9·5)个月,Lysholm膝关节功能评分为70~95分,平均(85·0±8·3)分。国际膝关节文件编制委员会(IKDC)综合评定由入院时显著异常(D级)9例,改进为随访时正常(A级)2例、接近正常(B级)6例、异常(C级)1例。结论膝关节多韧带损伤可在关节镜下ACL、PCL联合重建,分期或同期关节外韧带修复或重建,具有安全可靠、手术创伤小的优点,其治疗效果满意。更多还原

【Abstract】 Objective To explore the clinical characteristics of the multiple ligament injury of the knees, evaluate the outcome of treatment for the multiple ligament injury of the knees.Methods From October 2001 to March 2005, 9 knees with combined anterior cruciate ligament(ACL) and posterior cruciate ligament(PCL) tear in 9 patients were verified with clinical and arthroscopic examination,5 knees were combined with rupture of the posteromedial corner (PMC) and medial collateral ligament (MCL), 4 combined with disruption of the posterolateral corner (PLC).The repair of PMC and MCL in 4 patients were performed in the acute phase. Arthroscopic combined reconstruction of ACL and PCL with autografts was performed in all patients from 4 to 10 weeks after trauma. The reconstruction of PLC with the posterior half of biceps femoris tendon tenodesis in 4 patients and reconstruction of PMC and MCL with femoral fascia in 1 patient were completed simultaneously. Results All of them were followed up for 10 to 39 months with an average of 23.0±9.5 months. Lysholm score was between 70 and 95 with an average of 85.0±8.3.Furthermore, there was a significant improvement in international knee documentation committee (IKDC) score from severely abnormal (grade D) in 9 knee at initial examination to normal (grade A) in 2 knees, nearly normal (grade B) in 6 knees and abnormal (grade C) in 1 knee at follow up.Conclusion Arthroscopic combined reconstruction of ACL and PCL combined with repair or reconstruction of the extraarticular ligaments simultaneously or in stages has advantages such as the minimal trauma in surgery and reliable satisfactory outcome.更多还原