中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2012年
6期
545-550
,共6页
王少杰%夏春%石磊%傅日斌%林原
王少傑%夏春%石磊%傅日斌%林原
왕소걸%하춘%석뢰%부일빈%림원
膝脱位%韧带%创伤和损伤%关节镜检查
膝脫位%韌帶%創傷和損傷%關節鏡檢查
슬탈위%인대%창상화손상%관절경검사
Knee dislocation%Ligament%Wound and injuries%Arthroscopy
目的 探讨膝关节脱位的治疗策略及临床疗效.方法 对单侧膝关节脱位36例进行回顾性分析,男22例,女14例,年龄19～72岁,平均35岁.按改良Schenck膝关节脱位分型,急性膝关节脱位30例,其中KD-Ⅰ型7例(X线表现为旋转型膝关节脱位)、KD-Ⅲ型23例；陈旧性膝关节脱位6例,均为KD-Ⅲ型.KD-Ⅰ型急性膝关节脱位7例、KD-Ⅲ型陈旧性膝关节脱位6例均行一期关节镜下十字韧带重建术+侧副韧带重建或修复术.KD-Ⅲ型急性膝关节脱位23例中2例高龄患者采用手法复位及石膏固定；18例采用分期手术,先修复或重建侧副韧带,3周后再重建十字韧带；3例合并血管、神经损伤者行一期十字韧带重建术+侧副韧带重建或修复术.末次随访时行膝关节临床检查和功能评估.结果 全部病例随访18～36个月,平均27个月.末次随访时Lysholm膝关节评分(82.0±11.4)分,Tegner膝关节运动水平评分(5.5±1.3)分,关节活动度118.3°±19.2°,与术前比较均有改善(P＜0.01).8例(23.5％,8/34)残留膝关节不稳定:Sag征阳性和后抽屉试验(++)～(+++)8例,外翻应力试验(++)1例,内翻应力试验(+++)1例.结论 对KD-Ⅰ型急性膝关节脱位和KD-Ⅲ型陈旧性膝关节脱位可采用关节镜下一期手术；对KD-Ⅲ型急性膝关节脱位可采用分期手术,以降低术后关节僵硬的风险.
目的 探討膝關節脫位的治療策略及臨床療效.方法 對單側膝關節脫位36例進行迴顧性分析,男22例,女14例,年齡19～72歲,平均35歲.按改良Schenck膝關節脫位分型,急性膝關節脫位30例,其中KD-Ⅰ型7例(X線錶現為鏇轉型膝關節脫位)、KD-Ⅲ型23例；陳舊性膝關節脫位6例,均為KD-Ⅲ型.KD-Ⅰ型急性膝關節脫位7例、KD-Ⅲ型陳舊性膝關節脫位6例均行一期關節鏡下十字韌帶重建術+側副韌帶重建或脩複術.KD-Ⅲ型急性膝關節脫位23例中2例高齡患者採用手法複位及石膏固定；18例採用分期手術,先脩複或重建側副韌帶,3週後再重建十字韌帶；3例閤併血管、神經損傷者行一期十字韌帶重建術+側副韌帶重建或脩複術.末次隨訪時行膝關節臨床檢查和功能評估.結果 全部病例隨訪18～36箇月,平均27箇月.末次隨訪時Lysholm膝關節評分(82.0±11.4)分,Tegner膝關節運動水平評分(5.5±1.3)分,關節活動度118.3°±19.2°,與術前比較均有改善(P＜0.01).8例(23.5％,8/34)殘留膝關節不穩定:Sag徵暘性和後抽屜試驗(++)～(+++)8例,外翻應力試驗(++)1例,內翻應力試驗(+++)1例.結論 對KD-Ⅰ型急性膝關節脫位和KD-Ⅲ型陳舊性膝關節脫位可採用關節鏡下一期手術；對KD-Ⅲ型急性膝關節脫位可採用分期手術,以降低術後關節僵硬的風險.
목적 탐토슬관절탈위적치료책략급림상료효.방법 대단측슬관절탈위36례진행회고성분석,남22례,녀14례,년령19～72세,평균35세.안개량Schenck슬관절탈위분형,급성슬관절탈위30례,기중KD-Ⅰ형7례(X선표현위선전형슬관절탈위)、KD-Ⅲ형23례；진구성슬관절탈위6례,균위KD-Ⅲ형.KD-Ⅰ형급성슬관절탈위7례、KD-Ⅲ형진구성슬관절탈위6례균행일기관절경하십자인대중건술+측부인대중건혹수복술.KD-Ⅲ형급성슬관절탈위23례중2례고령환자채용수법복위급석고고정；18례채용분기수술,선수복혹중건측부인대,3주후재중건십자인대；3례합병혈관、신경손상자행일기십자인대중건술+측부인대중건혹수복술.말차수방시행슬관절림상검사화공능평고.결과 전부병례수방18～36개월,평균27개월.말차수방시Lysholm슬관절평분(82.0±11.4)분,Tegner슬관절운동수평평분(5.5±1.3)분,관절활동도118.3°±19.2°,여술전비교균유개선(P＜0.01).8례(23.5％,8/34)잔류슬관절불은정:Sag정양성화후추체시험(++)～(+++)8례,외번응력시험(++)1례,내번응력시험(+++)1례.결론 대KD-Ⅰ형급성슬관절탈위화KD-Ⅲ형진구성슬관절탈위가채용관절경하일기수술；대KD-Ⅲ형급성슬관절탈위가채용분기수술,이강저술후관절강경적풍험.
Objective To discuss the treatment strategy of knee dislocation and to evaluate its outcome.Methods Thirty-six patients with unilateral knee dislocation treated with individualized protocol were studied retrospectively,including 22 males and 14 females with an average age of 35 years (range,19-72 years).There were 30 acute and 6 chronic knee dislocations.According to the modified Schenck's classification of knee dislocation,there were 7 KD- Ⅰ and 23 KD-Ⅲ cases in the acute category,and all 6 chronic cases were KD-Ⅲ.Seven acute KD- Ⅰ and 6 chronic KD-Ⅲ cases underwent one-stage arthroscopic surgery.In 23 acute KD-Ⅲ cases,2 were treated conservatively with splint or brace due to advanced age,18 with staged surgery,3 with one-stage surgery due to concomitant vascular and nerve injury.Functional and clinical evaluation was conducted at final follow-up.Results All 36 patients were followed up for an average of 27 months (range,18-36 months).The Lysholm score (82.0±11.4),Tegner score (5.5±1.3),and knee range of motion (118.3°±19.2°) at final follow-up showed a statistically significant improvement compared with preoperative results (P＜O.O1).Eight (23.5％) patients had residual knee instability:posterior drawer test and Sag sign were positive (++ or +++) in 8 knees,valgus instability (++) in 1 and varus instability (+++) in 1.The remaining 28 knees were stable.Conclusion Special attention should be paid to rotational knee dislocation with single cruciate ligament rupture.Properly individualized treatment plan is the key to optimal outcome.Arthroscopic surgery can lead to successful outcome.Early one-stage arthroscopic surgery is recommended for acute KD-Ⅰ and chronic KD-Ⅲ dislocation,staged arthroscopic surgery for acute KD-Ⅲ dislocation.
