关节镜下膝前交叉韧带与后交叉韧带联合重建.doc

1 关节镜下膝前交叉韧带与后交叉韧带联合重建作者:孙磊,宁志杰,田敏,宁廷民,张红,罗毅, 马清元,高加智,刘欣欣【关键词】前交叉韧带摘要: [目的]探讨膝关节双交叉韧带损伤的临床特点, 评估关节镜下前交叉韧带(ACL) 与后交叉韧带( PCL )联合重建的技术和效果。[ 方法]自 2001 年9月~2005 年2月, 13 例病人( 13 膝)经关节镜检查证实 ACL 和 PCL 均断裂, 其中 5 膝伴后内侧角(PMC) 、内侧副韧带损伤(MCL) ,4 膝伴后外侧角损伤(PLC) ,2 膝伴外侧半月板破裂,1 膝伴内侧半月板损伤,3 膝伴动脉损伤,2 膝伴腓总神经损伤。7 例病人于损伤后急性期入院, 2 膝于急性期行血管探查修复, 4膝行膝后内侧角、内侧副韧带修复。 13 例病人于伤后 4~12 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 股二头肌腱重建后 PLC ,1 例同期阔筋膜 PMC 、 MCL 重建。[ 结果] 本组术后早期均未发生严重并发症。术后随访 10~39 个月, 平均( 2185 ± 928 ) 个月, Lyshol m 2 膝关节功能评分为 75~95 分, 平均( 8654 ± 689 )分。国际膝关节文件编制委员会( IKDC ) 综合评定由术前显著异常(D 级) 13 例,改进为随访时正常( A 级) 3 例、接近正常( B 级) 8 例、异常( C 级) 2 例。 13 例病人中, 11 例恢复至伤前运动水平,2 例运动水平较伤前减低。[ 结论] 膝关节双交叉韧带损伤多伴有其它重要结构损伤, 需妥善处理合并损伤。关节镜下自体移植物联合单束重建 ACL 和 PCL 创伤小、手术操作精细,术后膝关节功能恢复满意。关键词: 膝关节; 前交叉韧带; 后交叉韧带; 关节镜; 四股绳肌腱; 单束重建 Abstract :[ Objective ] To explore the clinical characteristics of bicruciate ligament injury of the knee, evaluate the technique and e of bined reconstruction of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) with autografts. [ Method ] From Sept 2001 to Feb 2005, 13 knees bined ACL and PCL tear in 13 patients were verified with arthroscopy. Of them, 5 knee bined with rupture of the posteromedial coner (PMC) and medial collateral ligament (MCL), bined with disruption of the posterolateral corner (PLC), 2 with lateral meniscus tear, 1 with 3 medial meniscus tear, 3 associated with popliteal vascular injury and 2 with peroneal nerve injury. Seven patients were admitted into this department in acute phase of trauma, repair of popliteal artery in2 patients and repair of PMC and MCL in4 patients were performed in this phase. bined reconstruction of ACL and PCL with autografts was performed in all patients from 4 to 12 weeks after trauma, reconstruction of PLC with the posterior half of biceps femoris tendon tenodesis in3 patients and reconstruction of PMC and MCL with femoral fascia in1 patient pleted simultaneously. [ Result ] No plications occurred in early stage