膝关节后内侧结构损伤合并交叉韧带断裂的手术治疗_《中国修复重建外科杂志》

作者：

陈志伟 , 盛真 , 戴祝

南华大学附属第一医院骨科（湖南衡阳，421001）;

关键词：

膝后内侧结构交叉韧带关节镜缝合锚钉

DOI：

10.7507/1002-1892.20130129

视频：

导出 下载 收藏 扫码 引用

摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的探讨手术治疗膝关节后内侧结构（posteromedial corner，PMC）损伤合并前交叉韧带（anterior cruciate ligament，ACL）、后交叉韧带（posterior cruciate ligament，PCL）断裂的方法及疗效。方法2009年2月－2012年2月，收治15例15膝PMC损伤合并ACL、PCL断裂患者，采用缝合锚钉修复PMC联合一期或二期重建ACL、PCL治疗。男7例，女8例；年龄15～59岁，平均39岁。致伤原因：交通事故伤6例，运动伤7例，扭伤2例。受伤至手术时间3～15 d，平均7 d。外翻应力试验及前、后抽屉试验均呈阳性，关节功能障碍。ACL和PCL断裂3例，ACL断裂5例，ACL胫骨髁间嵴撕脱3例，PCL断裂4例。PMC于股骨止点撕裂9例，胫骨止点撕裂5例，体部撕裂1例。结果术后切口均Ⅰ期愈合，无并发症发生。15例均获随访，随访时间10～36个月，平均18.4个月。末次随访时14例膝关节屈、伸范围正常，1例伸直受限10°。外翻应力试验除1例呈弱阳性外，其余患者均为阴性；前、后抽屉试验均为阴性。采用改良Lysholm评分标准评定疗效：获优8例，良5例，可2例，优良率86.7%。结论膝关节PMC损伤合并ACL、PCL断裂时，早期修复PMC并合理修复重建交叉韧带能有效恢复膝关节稳定性。

引用本文： 陈志伟,盛真,戴祝. 膝关节后内侧结构损伤合并交叉韧带断裂的手术治疗. 中国修复重建外科杂志, 2013, 27(5): 586-590. doi: 10.7507/1002-1892.20130129 复制

1.	Robinson JR, Sanchez-Ballester J, Bull AM, et al. The posteromedial corner revisited. An anatomical description of the passive restraining structures of the medial aspect of the human knee. J Bone Joint Surg (Br), 2004, 86(5): 674-681.
2.	Sims WF, Jacobson KE. The posteromedial corner of the knee: medial sided injury patterns revisited. J Sports Med, 2004, 32(2): 337-345.
3.	Benjamin Jackson 3rd, Ferguson CM, Martin DF. Surgial treatment of chronic posteromedial instability using capsular procedures. Sports Med Arthrosc, 2006, 14(2): 91-95.
4.	Fanelli GC, Harris JD. Surgical treatment of medial collateral ligament and posteromedial corner injuries of the knee. Sports Med Arthrosc, 2006, 14(2): 78-83.
5.	Jacobson KE, Chi FS. Evaluation and treatment of medial collateral ligament and medial-sided injuries of the knee. Sports Med Artherosc, 2006, 14(2): 58-66.
6.	Steadman JR, Briggs KK, Rodrigo JJ, et al. Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up. Arthroscopy, 2003, 19(5): 477-484.
7.	Kawano CT, Bispo RZ Jr, Oliveira MG, et al. Posterolateral knee instability: an alternative proposal for surgical treatment. Clinics (Sao Paulo), 2007, 62(3): 371-374.
8.	Cameron JC, Saha S. Meniscal allograft transplantation for unicompartmental arthritis of the knee. Clin Orthop Relat Res, 1997, (337): 164-171.
9.	范钦波, 范继峰. 关节镜下先进人工韧带加强系统和四股自体半腱肌腱重建前交叉韧带的疗效比较. 中国修复重建外科杂志, 2008, 22(6): 676-679.
10.	Fanelli GC, Harris JD. Surgical treatment of acute medial collateral ligament and posteromedial corner injuries of the knee. Sports Med Arthrosc, 2006, 14(2): 78-83.
11.	Halinen J, Lindahl J, Hirvensalo E. Range of motion and quadriceps power after early surgical treatment of acute combined anterior cruciate and grade-III medial collateral ligament injuries. A prospective randomized study. J Bone Joint Surg (Am), 2009, 91(6): 1305-1312.
12.	Osti L, Papalia R, Del Buono A, et al. Simultaneous surgical management of chronic grade-2 valgus instability of the knee and anterior cruciate ligament deficiency in athletes. Knee Surg Sports Traumatol Arthrosc, 2010, 18(3): 312-316.
13.	Munshi M, Davidson M, MacDonald PB, et al. The efficacy of magnetic resonance imaging in acute knee injuries. Clin J Sport Med, 2007, 10(1): 34-39.
14.	Alioto RJ, Browne JE, Barnthouse CD, et al. The influence of MRI on treatment decisions regarding knee injuries. Am J Knee Surg, 1999, 12(2): 91-97.
15.	Griffith CJ, Wijdicks CA, LaPrade RF, et al. Force measurements on the posterior oblique ligament and superficial medial collateral ligament proximal and distal divisions to applied loads. Am J Sports Med, 2009, 37(1): 140-148.
16.	Sims WF, Jacobson KE. The posteromedial corner of the knee: medial-sided injury patterns revisited. Am J Sports Med, 2004, 32(2): 337-345.
17.	孙磊, 宁廷民, 田敏, 等. 关节镜下自体四股腘绳肌腱重建膝前交叉韧带. 中华创伤杂志, 2005, 21(5): 336-340.
18.	Wijdicks CA, Griffith CJ, Johansen S, et al. Injuries to the medial collateral ligament and associated medial structures of the knee. J Bone Joint Surg (Am), 2010, 92(5): 1266-1280.

1. Robinson JR, Sanchez-Ballester J, Bull AM, et al. The posteromedial corner revisited. An anatomical description of the passive restraining structures of the medial aspect of the human knee. J Bone Joint Surg (Br), 2004, 86(5): 674-681.
2. Sims WF, Jacobson KE. The posteromedial corner of the knee: medial sided injury patterns revisited. J Sports Med, 2004, 32(2): 337-345.
3. Benjamin Jackson 3rd, Ferguson CM, Martin DF. Surgial treatment of chronic posteromedial instability using capsular procedures. Sports Med Arthrosc, 2006, 14(2): 91-95.
4. Fanelli GC, Harris JD. Surgical treatment of medial collateral ligament and posteromedial corner injuries of the knee. Sports Med Arthrosc, 2006, 14(2): 78-83.
5. Jacobson KE, Chi FS. Evaluation and treatment of medial collateral ligament and medial-sided injuries of the knee. Sports Med Artherosc, 2006, 14(2): 58-66.
6. Steadman JR, Briggs KK, Rodrigo JJ, et al. Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up. Arthroscopy, 2003, 19(5): 477-484.
7. Kawano CT, Bispo RZ Jr, Oliveira MG, et al. Posterolateral knee instability: an alternative proposal for surgical treatment. Clinics (Sao Paulo), 2007, 62(3): 371-374.
8. Cameron JC, Saha S. Meniscal allograft transplantation for unicompartmental arthritis of the knee. Clin Orthop Relat Res, 1997, (337): 164-171.
9. 范钦波, 范继峰. 关节镜下先进人工韧带加强系统和四股自体半腱肌腱重建前交叉韧带的疗效比较. 中国修复重建外科杂志, 2008, 22(6): 676-679.
10. Fanelli GC, Harris JD. Surgical treatment of acute medial collateral ligament and posteromedial corner injuries of the knee. Sports Med Arthrosc, 2006, 14(2): 78-83.
11. Halinen J, Lindahl J, Hirvensalo E. Range of motion and quadriceps power after early surgical treatment of acute combined anterior cruciate and grade-III medial collateral ligament injuries. A prospective randomized study. J Bone Joint Surg (Am), 2009, 91(6): 1305-1312.
12. Osti L, Papalia R, Del Buono A, et al. Simultaneous surgical management of chronic grade-2 valgus instability of the knee and anterior cruciate ligament deficiency in athletes. Knee Surg Sports Traumatol Arthrosc, 2010, 18(3): 312-316.
13. Munshi M, Davidson M, MacDonald PB, et al. The efficacy of magnetic resonance imaging in acute knee injuries. Clin J Sport Med, 2007, 10(1): 34-39.
14. Alioto RJ, Browne JE, Barnthouse CD, et al. The influence of MRI on treatment decisions regarding knee injuries. Am J Knee Surg, 1999, 12(2): 91-97.
15. Griffith CJ, Wijdicks CA, LaPrade RF, et al. Force measurements on the posterior oblique ligament and superficial medial collateral ligament proximal and distal divisions to applied loads. Am J Sports Med, 2009, 37(1): 140-148.
16. Sims WF, Jacobson KE. The posteromedial corner of the knee: medial-sided injury patterns revisited. Am J Sports Med, 2004, 32(2): 337-345.
17. 孙磊, 宁廷民, 田敏, 等. 关节镜下自体四股腘绳肌腱重建膝前交叉韧带. 中华创伤杂志, 2005, 21(5): 336-340.
18. Wijdicks CA, Griffith CJ, Johansen S, et al. Injuries to the medial collateral ligament and associated medial structures of the knee. J Bone Joint Surg (Am), 2010, 92(5): 1266-1280.

《中国修复重建外科杂志》

膝关节后内侧结构损伤合并交叉韧带断裂的手术治疗

摘要 全文 图表 视频 参考文献 施引文献 补充材料

上一篇

下一篇

Format

Content

《中国修复重建外科杂志》

膝关节后内侧结构损伤合并交叉韧带断裂的手术治疗

摘要 全文 图表 视频 参考文献 施引文献 补充材料

上一篇

下一篇

Format

Content

摘要全文图表视频参考文献施引文献补充材料