【作者】 刘昱江； 王云刚； 闫生亮；

【机构】 银川市第一人民医院骨科；

【摘要】 目的:通过回顾膝关节后内侧角的解剖结构,进行关节镜辅助下半膜肌动力加强膝关节后内侧结构损伤(PMC)的手术,探讨后内侧结构损伤的重建方法及疗效。方法:2009年7月～2011年12月共治疗21例后内侧结构损伤中12例合并ACL断裂,5例合并PCL断裂,4例为单纯后内侧角损伤。内翻应力试验检查:0°位+++19例,2例++,30°位+++21例,Slocum试验阳性19例。10例ACL断裂采用对侧自体半腱肌、股薄肌重建ACL(Endobutton+Interference Screw)术式半腱肌腱重建,2例ACL于胫骨止点撕脱关节镜下复位空心钉固定,5例PCL断裂采用对侧半腱肌腱重建(InterferenceScrew)。所有合并后内侧角损伤患者均行半膜肌腱移位动力加强替代。[结果 ]本组21例中2例随访4个月后失访,平均随访12个月(6～18个月),术后6个月和12个月行关节功能评定.外翻应力试验0°和屈膝30°位均正常18例;0°位正常,屈膝30°位表现为Ⅰ°不稳2例.关节屈膝活动术后12个月(121±19)°.Lysholm评分术后术后12个月(92.03±0.91)分.手术前后比较差异有统计学意义(P<0.05).IKDC评级:A级17例,B级5例,C级0例.术后12个月Tegner膝关节运动水平评分和关节活动度较术前提高5分,关节活动度提高50°疗效评定:优良18例,中2例.Slocum试验均为阴性[结论 ]膝关节后内侧结构的急性损伤可导致膝关节的严重不稳定.半膜肌移位动力加强治疗膝关节后内侧角急性损伤恢复膝关节内后侧稳定性,术式简单,节省时间。可以收到较好的手术效果。更多还原

【Abstract】 Objective To explore the surgical techniques and therapeutic effects of ipsilateral semimembranosus dinamic enhance technique were achieved in patients suffering from Posteromedial Complex injury.Methods From July 2009to December 2011,21 patients with Posteromedial Complex injury were treated with semimembranosus dynamic enhance.Median age was 22.4 years(range,18 - 44).12 had combined anterior cruciate ligament(ACL) injury,and 5 had posterior cruciate ligament(PCL) injury,4 cases underwent isolated PMC injury.All patients had reconstruction of the medial collateral and the posteromedial complex using ipsilateral semimembranosus dinamic enhance.Ninety patients were available for follow-up more than 12months postoperatively and were examined by an independent observer using objective International Knee Documentation Committee(IKDC) measures and Lysholm Score.Results All the cases were followed up for an averge of 12months(from6tol8months)..The averge Lysholm score wasl2.4±12.5before surgery and 92.03±0.91 at the last follow-up, with a significant difference(t=27.750,P=0.000).The Tegner score 5.5±1.3,and Knee range of motion 118±19°at final follow-up showed a statistically significant improvement compared with preoperative result.IKDC grade was:Agrade:16cases,Bgrade:3cases at last follow-up.By the Slocum test:21cases were negative.Valgus stress test(Odegree,30degree) was:16cases normal,2cases show instabilityⅠ°under flexed knee 30degree.The knee flexible(121±19)°at last follow-up. Conclusion Acceptable clinical results with ipsilateral semimembranosus dinamic enhance technique were achieved in patients suffering from Posteromedial Complex injury.更多还原