膝關節后內側結構損傷合并交叉韌帶斷裂的手術治療_《中國修復重建外科雜志》

作者：

陳志偉 , 盛真 , 戴祝

南華大學附屬第一醫院骨科（湖南衡陽，421001）;

關鍵詞：

膝后內側結構交叉韌帶關節鏡縫合錨釘

DOI：

10.7507/1002-1892.20130129

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目的探討手術治療膝關節后內側結構（posteromedial corner，PMC）損傷合并前交叉韌帶（anterior cruciate ligament，ACL）、后交叉韌帶（posterior cruciate ligament，PCL）斷裂的方法及療效。方法2009年2月－2012年2月，收治15例15膝PMC損傷合并ACL、PCL斷裂患者，采用縫合錨釘修復PMC聯合一期或二期重建ACL、PCL治療。男7例，女8例；年齡15～59歲，平均39歲。致傷原因：交通事故傷6例，運動傷7例，扭傷2例。受傷至手術時間3～15 d，平均7 d。外翻應力試驗及前、后抽屜試驗均呈陽性，關節功能障礙。ACL和PCL斷裂3例，ACL斷裂5例，ACL脛骨髁間嵴撕脫3例，PCL斷裂4例。PMC于股骨止點撕裂9例，脛骨止點撕裂5例，體部撕裂1例。結果術后切口均Ⅰ期愈合，無并發癥發生。15例均獲隨訪，隨訪時間10～36個月，平均18.4個月。末次隨訪時14例膝關節屈、伸范圍正常，1例伸直受限10°。外翻應力試驗除1例呈弱陽性外，其余患者均為陰性；前、后抽屜試驗均為陰性。采用改良Lysholm評分標準評定療效：獲優8例，良5例，可2例，優良率86.7%。結論膝關節PMC損傷合并ACL、PCL斷裂時，早期修復PMC并合理修復重建交叉韌帶能有效恢復膝關節穩定性。

引用本文： 陳志偉,盛真,戴祝. 膝關節后內側結構損傷合并交叉韌帶斷裂的手術治療. 中國修復重建外科雜志, 2013, 27(5): 586-590. doi: 10.7507/1002-1892.20130129 復制

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.	范欽波, 范繼峰. 關節鏡下先進人工韌帶加強系統和四股自體半腱肌腱重建前交叉韌帶的療效比較. 中國修復重建外科雜志, 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.	孫磊, 寧廷民, 田敏, 等. 關節鏡下自體四股腘繩肌腱重建膝前交叉韌帶. 中華創傷雜志, 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. 范欽波, 范繼峰. 關節鏡下先進人工韌帶加強系統和四股自體半腱肌腱重建前交叉韌帶的療效比較. 中國修復重建外科雜志, 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. 孫磊, 寧廷民, 田敏, 等. 關節鏡下自體四股腘繩肌腱重建膝前交叉韌帶. 中華創傷雜志, 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.

《中國修復重建外科雜志》

膝關節后內側結構損傷合并交叉韌帶斷裂的手術治療

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《中國修復重建外科雜志》

膝關節后內側結構損傷合并交叉韌帶斷裂的手術治療

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