摘要
目的探讨膝后外侧结构(posterolateral complex,PLC)损伤的诊断和不同的手术方式间的疗效分析。方法 2002年6月至2011年3月期间,我院共收治的198例PLC损伤患者,男126例,女72例;年龄15～58岁,平均38.6岁;急性损伤152例,陈旧损伤46例。病程2天至28个月。术前伸直位内翻不稳Ⅲ度134例,Ⅱ度64例;屈膝30°位内翻不稳Ⅲ度156例,Ⅱ度42例。患侧小腿外旋较健侧增加10°～30°,平均25°。Lachman试验阳性33例,前抽屉试验阳性36例,后抽屉试验阳性98例,前后抽屉试验均阳性者28例。术前行X线片、MRI等影像学检查及关节镜检查关节的松弛程度和前后交叉韧带的断裂程度及半月板损伤类型等。在行合并前后交叉韧带损伤重建及半月板损伤处理等同时,根据后外侧结构损伤的类型和程度对PLC损伤进行骨折内固定术、韧带重建术、PLC股骨止点上移术三种不同的治疗方法。结果 198例均获随访,时间为6-30个月,术后6个月检查,伸直受限10°2例,5°4例,屈膝活动度均超过120°。稳定性检查,伸直位无内翻不稳;屈膝30。位Ⅰ度内翻不稳伴硬性止点3例。患侧小腿外旋较健侧增加者4例,均<5°。术后Lachman试验、前抽屉试验、后抽屉试验均为阴性。术后1年随访185例,伸直受限10°1例,5°3例,与6个月时比较无明显变化。术后1年随访的185例HSS评分结果为:优165例,良20例,中0例,差0例,优良率100%。最后随访时间为术后30个月,共102例获随访,HSS评分结果为:优90例,良10例,中2例,差0例,优良率98.4%。结论依据具体的损伤的类型、组织撕裂程度和部位采用不同手术方式进行膝后外侧结构修复,恢复膝关节在各方位活动时后外侧的稳定,能够为患者提供更为满意的治疗。
Objective To investigate the diagnosis of posterolateral knee complex injuries and the differences of curative effects among different treatment methods. Methods 198 patients with posterolateral knee complex injuries were adopted by out hospital from June 2002 to March 2011, among whom there were 126 males and 72 females, whose average age was 38.6 years old （range; 15-58 years）. There were 152 cases of acute injuries and 46 cases of old injuries. The course of disease was from 2 days to 28 months. Preoperatively, there were 134 cases of grade III varus instability at straight position and 64 cases of grade II; 156 cases of grade III varus instability in 30° flexion and 42 cases of grade II. The external rotation angle of the injured limb increased 25° on average （range; 10°- 30°）, when compared with the normal side. There were 33 positive cases by Lachman test. 36 patients had positive anterior drawer test, 98 patients had positive posterior drawer test, and 28 patients had both positive anterior drawer test and positive posterior drawer test. Preoperatively, the imaging examinations such as X-ray, MRI, etc and arthroscopy were preformed to show the degree of joint laxity, the rupture degree of the anterior and posterior cruciate ligament, the types of meniscal tears and so on. When combined anterior and posterior cruciate ligament reconstruction and the treatment of meniscus tears were carried out, 3 different treatment methods were used to treat posterolateral complex injuries according to the types and degree of posterolateral complex injuries, including fracture internal fixation, ligament reconstruction and the upper shift of femoral attachment site. Results 198 patients were followed up for 6 to 30 months. In the examination 6 months after surgery, 2 patients had 10° limitation of the extension, and 4 patients had 5°. The knee flexion of all patients was more than 120°. In the stability examination, there was no case of varus instability at straight position. 3 patients had grade I varus ins
出处
《中国骨与关节杂志》
CAS
2012年第6期611-614,共4页
Chinese Journal of Bone and Joint
关键词
膝关节后外侧结构
关节不稳定性
手术治疗
Posterolateral complex of the knee
Joint instability
Surgical treatment
