CAJ | 학술논문

目的探讨采用局部修复和(或)异体肌腱重建治疗急性膝关节后外侧复合结构(posterolateral complex,PLC)损伤的方法及疗效.方法 2006年5月至2008年10月,收治急性PLC损伤患者12例,男9例,女3例;年龄23～47岁,平均31岁;合并后十字韧带损伤9例,合并前、后十字韧带同时损伤3例.首先在关节镜下采用异体肌腱解剖重建前、后十字韧带,然后对于PLC两端附着点撕脱损伤的患者采用铆钉固定、缝线缝合修复治疗;对于PLC实质部断裂的患者采用局部缝合修复和(或)异体肌腱重建的方法治疗.术后根据KT-1000、IKDC及Lysholm功能评定标准评价膝关节功能恢复情况.结果 12例患者均获得随访,随访时间12～18个月,平均13.3个月.膝关节活动度由术前118.00°±6.77°提高至术后130.75°±3.05°.KT-1000由术前(14.85±1.83)mm改善至术后(4.18±1.88)mm.根据IKDC 综合评定标准,A级7例,B级3例,C级1例,D级1例.Lysholm膝关节功能评分由术前35～44分[平均(38.83±3.16)分]提高至术后79～91分[平均(84.92±3.73)分].所有患者患膝均无感染及免疫排斥反应.3例患者住院期间B超显示患侧小腿肌间静脉血栓,经低分子肝素钙治疗后好转.2例患者膝关节屈曲较对侧少15°.结论对于急性PLC损伤患者,PLC两端附着点撕脱损伤采用铆钉固定、缝线缝合修复;实质部断裂的患者采用局部缝合修复和(或)异体肌腱重建治疗可取得较好的效果.
목적 탐토채용국부수복화(혹)이체기건중건치료급성슬관절후외측복합결구(posterolateral complex,PLC)손상적방법급료효.방법 2006년5월지2008년10월,수치급성PLC손상환자12례,남9례,녀3례;년령23～47세,평균31세;합병후십자인대손상9례,합병전、후십자인대동시손상3례.수선재관절경하채용이체기건해부중건전、후십자인대,연후대우PLC량단부착점시탈손상적환자채용류정고정、봉선봉합수복치료;대우PLC실질부단렬적환자채용국부봉합수복화(혹)이체기건중건적방법치료.술후근거KT-1000、IKDC급Lysholm공능평정표준평개슬관절공능회복정황.결과 12례환자균획득수방,수방시간12～18개월,평균13.3개월.슬관절활동도유술전118.00°±6.77°제고지술후130.75°±3.05°.KT-1000유술전(14.85±1.83)mm개선지술후(4.18±1.88)mm.근거IKDC 종합평정표준,A급7례,B급3례,C급1례,D급1례.Lysholm슬관절공능평분유술전35～44분[평균(38.83±3.16)분]제고지술후79～91분[평균(84.92±3.73)분].소유환자환슬균무감염급면역배척반응.3례환자주원기간B초현시환측소퇴기간정맥혈전,경저분자간소개치료후호전.2례환자슬관절굴곡교대측소15°.결론 대우급성PLC손상환자,PLC량단부착점시탈손상채용류정고정、봉선봉합수복;실질부단렬적환자채용국부봉합수복화(혹)이체기건중건치료가취득교호적효과.
Objective To evaluate the surgical treatment of the acute posterolateral complex(PLC)injuries of knee joint and then observe the clinical outcome.Methods Twelve cases(12 knees)of acute PLC injuries were treated from May 2006 to October 2008.Patients' age ranged from 23 to 47 years old,average 31 years.There were 9 males and 3 females.Rebuild the anterior cruciate ligament(ACL)and posterior cruciate ligament(PCL)under arthroscope and then,locally suture the PLC injuries sites on those patients with PLC avulsion fraction.If there is PLC rupture,then locally suture the injury sites plus PLC reconstruction.Knee functions were evaluated by IKDC and Lysholm score.Results All patients were followed up for 12-18 months(mean,13.3 months).The preoperative range of motion was 118.00°±6.77°,which was 130.75°±3.05° after surgery.KT-1000 arthrometer measurement showed that the average posterior translation improved from(14.85+1.83)mm preoperatively to(4.18±1.88)mm postoperatively.Seven cases were normal(A grade),3 cases were nearly normal(B grade),1 abnormal(C grade),and 1 severely abnormal(D grade)according to IKDC standard.The preoperative Lysholm joint function score was 35-44,average 38.83 ±3.16,which was 79-91,average 84.92±3.73 after surgery.Conclusion To those acute PLC injuries with avulsion at the ligament extremities,locally suture should be taken.But for those with PLC rupture at the mid part of ligament,locally suture the injury sites plus PLC reconstruction helps get satisfactory outcome.