膝关节后交叉韧带合并后外侧角损伤Combined posterior cruciate ligament with posterolateral corner injuries of the knee
孙磊;宁志杰;田敏;宁廷民;张红;马清元;高加智;刘欣欣;
摘要(Abstract)：
[目的]探索膝关节后交叉韧带(PCL)合并后外侧角(PLC)损伤的临床特征,评估同期关节镜下四股腘绳肌腱单束重建膝PCL和后1/2股二头肌腱重建PLC的技术和效果。[方法]自2001年12月～2004年12月,14例病人(14膝)重度膝关节不稳入住本科,均表现为3+后抽屉试验阳性,内翻试验阳性,外旋试验患膝较健侧>10°,关节镜检查证实为PCL断裂,膝后外侧间隙张开,外侧半月板抬高,腘肌腱断裂。2例伴腓总神经损伤。均于关节镜下行自体四股腘绳肌腱单束PCL重建术,后侧1/2股二头肌腱PLC重建术。[结果]本组术后早期均未发生严重并发症。14例均获得随访,随访时间12～33个月,平均(21.14±7.26)个月。膝关节后侧稳定性有非常明显进步。膝关节伸直位、屈曲30°位内翻试验均为阴性。膝关节屈曲30°、90°位外旋试验双侧差均<10°。Lysholm膝关节功能评分为70～95分,平均(86.79±7.23)分,较术前(40～60)分,平均(47.14±8.25)分)明显改进(P<0.01)。IKDC综合评定正常(A级)4膝、接近正常(B级)9膝、异常(C级)1膝,较术前[异常(C级)3膝、显著异常(D级)11膝]有非常明显的改进(Z=3.296,P<0.001)。14例患者中,12例恢复伤前运动水平,2例运动水平较伤前减低。[结论]PCL损伤常合并PLC损伤,表现为重度后侧不稳和后外侧旋转不稳。关节镜下单束重建膝PCL,同期后侧1/2股二头肌腱重建PLC,手术损伤小、术后膝关节功能恢复满意。
关键词(KeyWords)： 膝关节;后交叉韧带;四股腘绳肌腱;膝后外侧角;股二头肌腱;关节镜
基金项目(Foundation):
作者(Author): 孙磊;宁志杰;田敏;宁廷民;张红;马清元;高加智;刘欣欣;
Email:
DOI:
参考文献(References)：
- [1]ClancyWGJr,SutherlandTB:Combinedposteriorcmciateligament injuries[J].ClinSportsMed,1994,13(3):629-647.
- [2]FanelliGC,EdsonCJ:Posteriorcruciateligamentinjuriesintrauma patients:PartII[J].Arthroscopy,1995,11(5):526-529.
- [3]孙磊,宁志杰,田敏,等.关节镜下四股腘绳肌腱单束重建膝关节后交叉韧带[J].中国矫形外科杂志,2005,13(24):1854-1857.
- [4]HamerCD,HoherJ:Evaluationandtreatmentofposteriorcruciate ligamentinjuries[J].AmJSportsMed,1998,26(3):471-482.
- [5]NoyesFR,Barber-WestinSD:Surgicalrestorationtotreatchronic deficiencyoftheposterolateralcomplexandcruciateligamentsofthe kneejoint[J].AmJSportsMed,1996,24(4):415-426.
- [6]VeltriDM,WarrenRF.IsolatedandcombinedPCLinjuries[J].J AmAcadOrthopSurg1993;1(2):67-75.
- [7]KakarlapudiTK,BickerstaffDR.Kneeinstability:isolatedandcom plex[J].BrJSportsMed,2000,34(5):395-400.
- [8]FerrariDA.Arthroscopicevaluationofthepopliteus:cluestopostero laterallaxity[J].Arthroscopy,2005,21(6):721-726.
- [9]NoyesFR,Barber WestinSD.Posteriorcruciateligamentrevisionre construction,part1:causesofsurgicalfailurein52consecutiveoper ations[J].AmJSportsMed,2005,33(5):646-654.
- [10]孙磊,宁志杰,田敏,等.急性膝关节后内侧角损伤[J].中国矫形外科杂志,2005,13(20):1528-1531.
- [11]StannardJP,BrownSL,FarrisRC,etal.Theposterolateralcomerof theknee:repairversusreconstruction[J].AmJSportsMed,2005,33(6):881-888.
- [12]HughstonJC,JacobsonKE:Chronicposterolateralrotatoryinstability oftheknee[J].JBoneJointSurgAm,1985.67(3):351-359.
- [13]ClancyWGJr:Repairandreconstructionoftheposteriorcmciatelig ament.InChapmanMW,ed:Operativeorthopaedics,Philadelphia,JBLippincott,1988.
- [14]ArcieroRA.Anatomicposterolateralcomerkneereconstruction[J].Arthroscopy,2005,21(9):1147.
- [15]StannardJP,BrownSL,RobinsonJT,etal.Reconstructionofthepos terolateralcomeroftheknee[J].Arthroscopy.2005,21(9):1051-1059.
- [16]FanelliGC,EdsonCJ.Combinedposteriorcmciateligament postero lateralreconstructionswithAchillestendonallograftandbicepsfemo ristendontenodesis:2to10yearfollow up[J].Arthroscopy,2004,20(4):3MR39-45.