关节镜辅助治疗难复性膝关节后外侧脱位的临床疗效

发布时间：2018-04-13 06:49

本文选题：膝关节 + 脱位　；参考：《中国运动医学杂志》2016年12期

【摘要】：目的:探讨关节镜辅助治疗难复性膝关节后外侧脱位的临床疗效。方法:2009年1月至2014年5月,采用关节镜辅助治疗难复性膝关节后外侧脱位并随访2年以上患者13例,男8例,女5例;年龄27~56岁,平均37.8岁。受伤至手术时间1~3天,平均1.84天。所有患者于关节镜下复位后,一期重建前后交叉韧带并修复或重建损伤的内外侧副韧带。术后膝关节稳定性评价采用体格检查、KT-1000和Telos应力像,后两者测量结果根据IKDC膝关节检查表进行分类(正常、接近正常、异常和严重异常);患者临床功能评价采用IKDC评分、Lysholm评分、Tegner评分和满意率。结果:随访时间为24~56个月,平均32.6个月。末次随访时,患者膝关节活动度为2.69°±5.63°~132.69°±11.66°。Lachman试验和轴移试验均阴性12例,均1+阳性1例;后抽屉试验阴性11例,1+阳性2例;屈膝30°位内翻应力试验阴性13例;屈膝30°位外翻应力试验阴性11例,1+阳性1例,2+阳性1例。KT-1000示患者膝关节前后向总位移和单纯前移的侧-侧差值分别为2.15±1.57 mm和1.61±0.86 mm。Telos应力像示术后前移侧-侧差值为2.23±0.92 mm,后移为3.23±1.16 mm,内侧间隙为1.77±1.87 mm,外侧间隙为0.46±0.52 mm。患者术前IKDC评分、Lysholm评分和Tegner评分分别为11.13±2.27分、1.31±2.59分和0.00±0.00分,术后分别为79.76±8.33分、84.53±6.39分和5.07±1.26分,术前术后临床功能评分差异均有统计学意义(t=27.02,P=0.001;t=45.72,P=0.001;t=14.58,P=0.001)。其中10例患者对术后临床疗效表示满意或非常满意,满意率为76.9%。多重线性回归示患者体重指数与术后临床疗效的相关性有统计学意义(t=-4.21,P=0.001)。结论:采用关节镜辅助治疗难复性膝关节后外侧脱位,一期重建前后交叉韧带并修复或重建损伤的内外侧副韧带,患者术后膝关节稳定性和临床功能较术前均有显著改善,患者术后满意率达76.9%。
[Abstract]:Objective: to investigate the clinical effect of arthroscopic adjuvant treatment of posterolateral dislocation of refractory knee joint.Methods: from January 2009 to May 2014, 13 patients (8 males and 5 females) with intractable posterolateral dislocation of the knee were treated with arthroscopy and followed up for more than 2 years, with an average age of 37.8 years (2756 years).The time from injury to operation was 1 to 3 days, with an average of 1.84 days.After arthroscopic reduction, the anterior and posterior cruciate ligaments were reconstructed and the injured internal and external collateral ligaments were repaired or reconstructed.After operation, the knee joint stability was evaluated by physical examination KT-1000 and Telos stress images. The results of the latter two measurements were classified according to the IKDC knee joint examination table (normal, close to normal).IKDC score and Lysholm score and Tegner score and satisfaction rate were used to evaluate the clinical function of the patients.Results: the follow-up time was 24 ~ 56 months (mean 32.6 months).At the last follow-up, the range of motion of knee joint was 2.69 掳卤5.63 掳卤132.69 掳卤11.66 掳. Lachman test and axial shift test were all negative in 12 cases, all of them were positive in 1 case, 11 cases were negative in posterior drawer test, 13 cases were negative in flexion 30 掳varus stress test.Lateral displacement of knee joint was 2.15 卤1. 57mm and 1. 61 卤0. 86 mm.Telos stress imaging showed that the lateral-lateral difference of knee joint displacement was 2. 15 卤1. 57mm and 1. 61 卤0. 86 mm.Telos stress imaging showed that the lateral-lateral difference of knee joint total displacement and simple forward displacement were 2. 15 卤1. 57mm and 1. 61 卤0. 86 mm.Telos respectively2.23 卤0.92 mm, 3.23 卤1.16 mm, 1.77 卤1.87 mm in medial space and 0.46 卤0.52 mm in lateral space.Among them, 10 cases were satisfied or very satisfied with the clinical effect after operation, the satisfaction rate was 76. 9%.Multiple linear regression analysis showed that the correlation between body mass index (BMI) and postoperative clinical efficacy was statistically significant.Conclusion: arthroscopic adjuvant treatment of posterolateral dislocation of the refractory knee joint, primary reconstruction of anterior and posterior cruciate ligaments and repair or reconstruction of the injured internal and external collateral ligaments, the stability and clinical function of the knee joint after operation were significantly improved compared with those before operation.The satisfaction rate of the patients was 76. 9%.
【作者单位】：厦门大学附属福州第二医院运动损伤科;
【基金】：福建省自然科学基金项目(2016J01481)
【分类号】：R687.4

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