膝关节多发韧带损伤中后外侧复合体的解剖重建_《中国修复重建外科杂志》

作者：

张东亮 , 王磊 , 曹建刚 , 刘军

天津市人民医院暨南开大学人民医院关节外科（天津，300121）;

关键词：

膝关节后外侧复合体多发韧带损伤解剖重建

DOI：

10.7507/1002-1892.20130101

视频：

导出 下载 收藏 扫码 引用

摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的探讨膝关节多发韧带损伤中后外侧复合体（posterolateral complex，PLC）解剖重建的方法及近期疗效。方法2007年6月－2011年7月，收治23例膝关节多发韧带损伤患者。男15例，女8例；年龄19～56岁，平均41岁。交通事故伤9例，扭伤7例，砸伤3例，高处坠落伤4例。损伤至手术时间13～78 d，平均32 d。患者后抽屉试验及Lachman试验均呈阳性，均伴内翻、外旋不稳。膝关节Lysholm评分为（43.4 ± 5.7）分。国际膝关节文献委员会（IKDC）综合评分均为D级。PLC损伤根据Fanelli分型标准，均为C型。X线片检查示，后方应力下胫骨后移（13.3 ± 4.2）mm，内翻应力下外侧关节间隙张开（15.1 ± 2.4）mm。术中取自体同侧/对侧半腱肌、股薄肌肌腱，必要时联合同种异体肌腱，关节镜下重建前、后交叉韧带，并联合后外侧切口行PLC静力性解剖重建。结果术后切口均Ⅰ期愈合，无相关并发症发生。患者均获随访，随访时间12～56个月，平均28个月。末次随访时，患者后抽屉试验及Lachman试验均呈阴性， 3例内翻不稳，2例外旋不稳。膝关节Lysholm评分为（85.6 ± 16.7）分，与术前比较差异有统计学意义（t=11.469，P=0.000）。IKDC综合评分：A级7例，B级12例，C级4例；与术前比较差异有统计学意义（Z=4.285，P=0.000）。X线片检查示，后方应力下胫骨后移（5.1 ± 4.4）mm，内翻应力下外侧关节间隙张开（3.2 ± 2.8）mm，与术前比较差异均有统计学意义（P lt; 0.05）。结论在膝关节多发韧带损伤的治疗中，应用自体腘绳肌肌腱，必要时联合同种异体肌腱解剖重建PLC，可获得较好近期疗效。

引用本文： 张东亮,王磊,曹建刚,刘军. 膝关节多发韧带损伤中后外侧复合体的解剖重建. 中国修复重建外科杂志, 2013, 27(4): 436-439. doi: 10.7507/1002-1892.20130101 复制

1.	Ayala-Mejías JD, García-Estrada GA, Rodríguez-Hernández C, et al. Description of an arthroscopic and percutaneous technique to repair posterolateral corner knee lesions. Acta Ortop Mex, 2011, 25(6): 396-402.
2.	Dhillon M, Akkina N, Prabhakar S, et al. Evaluation of outcomes in conservatively managed concomitant Type A and B posterolateral corner injuries in ACL deficient patients undergoing ACL reconstruction. Knee, 2012, 19(6): 769-772.
3.	Zantop T, Schumacher T, Diermann N, et al. Anterolateral rotational knee instability: role of posterolateral structures. Arch Orthop Trauma Surg, 2007, 127(9): 743-752.
4.	Kim SJ, Choi DH, Hwang BY. The influence of posterolateral rotatory instability on ACL reconstruction: comparison between isolated ACL reconstruction and ACL reconstruction combined with posterolateral corner reconstruction. J Bone Joint Surg (Am), 2012, 94(3): 253-259.
5.	Fanelli GC, Larson RV. Practical management of posterolateral instability of the knee. Arthroscopy, 2002, 18(2 Suppl 1): 1-8.
6.	赵金忠. 膝关节重建外科学. 郑州: 河南科学技术出版社, 2007: 155-178.
7.	Lee SH, Jung YB, Lee HJ, et al. Evaluation of tunnel position of posterolateral corner reconstruction using 3-Dimensional computed tomogram. Arthroscopy, 2012, 28(6): 844-854.
8.	LaPrade RF, Ly TV, Wentorf FA, et al. The posterolateral attachments of the knee: a qualitative and quantitative morphologic analysis of the fibular collateral ligament, popliteus tendon, popliteofibular ligament, and lateral gastrocnemius tendon. Am J Sports Med, 2003, 31(6): 854-860.
9.	Stannard JP, Brown SL, Robinson JT, et al. Reconstruction of the posterolateral corner of the knee. Arthroscopy, 2005, 21(9): 1051-1059.
10.	Petrigliano FA, Lane CG, Suero EM, et al. Posterior cruciate ligament and posterolateral corner deficiency results in a reverse pivot shift. Clin Orthop Relat Res, 2012, 470(3): 815-823.
11.	Ellingson CI, Kurtz CA, Sekiya JK. Non surgical management of lateral side injuries of the knee. Spors Med Arthrosc, 2006, 14(1): 20-22.
12.	Gardner MJ, Yacoubian S, Geller D, et al. The incidence of soft tissue injury in operative tibial plateau fractures: a magnetic resonance imaging analysis of 103 patients. J Orthop Trauma, 2005, 19(2): 79-84.
13.	Sekiya JK, Kurtz CA. Posterolateral corner reconstruction of the knee: surgical technique utilizing a bifid Achilles tendon allograft and a double femoral tunnel. Arthroscopy, 2005, 21(11): 1400.
14.	Feng H, Hong L, Geng XS, et al. Posterolateral sling reconstruction of the popliteus tendon: an all-arthrescopic technique. Arthroscopy, 2009, 25(7): 800-805．.
15.	Kim SJ, Kim TW, Kim SG, et al. Clinical comparisons of the anatomical reconstruction and modified biceps rerouting technique for chronic posterolateral instability combined with posterior cruciate ligament reconstruction. J Bone Joint Surg (Am), 2011, 93(9): 809-818．.
16.	Levy BA, Dajani KA, Morgan JA, et al. Repair versus reconstruction of the fibular collateral ligament and posterolateral corner in the multiligament-injured knee. Am J Sports Med, 2010, 38(4): 804-809.
17.	LaPrade RF, Johansen S, Agel J, et al. Outcomes of all anatomic posterolateral knee reconstruction. J Bone Joint Surg (Am), 2010, 92(1): 16-22.
18.	张辉, 洪雷, 王雪松, 等. 膝关节创伤性多发韧带损伤中后外复合体重建的临床疗效. 中华创伤骨科杂志, 2010, 12(4): 308-313．.

1. Ayala-Mejías JD, García-Estrada GA, Rodríguez-Hernández C, et al. Description of an arthroscopic and percutaneous technique to repair posterolateral corner knee lesions. Acta Ortop Mex, 2011, 25(6): 396-402.
2. Dhillon M, Akkina N, Prabhakar S, et al. Evaluation of outcomes in conservatively managed concomitant Type A and B posterolateral corner injuries in ACL deficient patients undergoing ACL reconstruction. Knee, 2012, 19(6): 769-772.
3. Zantop T, Schumacher T, Diermann N, et al. Anterolateral rotational knee instability: role of posterolateral structures. Arch Orthop Trauma Surg, 2007, 127(9): 743-752.
4. Kim SJ, Choi DH, Hwang BY. The influence of posterolateral rotatory instability on ACL reconstruction: comparison between isolated ACL reconstruction and ACL reconstruction combined with posterolateral corner reconstruction. J Bone Joint Surg (Am), 2012, 94(3): 253-259.
5. Fanelli GC, Larson RV. Practical management of posterolateral instability of the knee. Arthroscopy, 2002, 18(2 Suppl 1): 1-8.
6. 赵金忠. 膝关节重建外科学. 郑州: 河南科学技术出版社, 2007: 155-178.
7. Lee SH, Jung YB, Lee HJ, et al. Evaluation of tunnel position of posterolateral corner reconstruction using 3-Dimensional computed tomogram. Arthroscopy, 2012, 28(6): 844-854.
8. LaPrade RF, Ly TV, Wentorf FA, et al. The posterolateral attachments of the knee: a qualitative and quantitative morphologic analysis of the fibular collateral ligament, popliteus tendon, popliteofibular ligament, and lateral gastrocnemius tendon. Am J Sports Med, 2003, 31(6): 854-860.
9. Stannard JP, Brown SL, Robinson JT, et al. Reconstruction of the posterolateral corner of the knee. Arthroscopy, 2005, 21(9): 1051-1059.
10. Petrigliano FA, Lane CG, Suero EM, et al. Posterior cruciate ligament and posterolateral corner deficiency results in a reverse pivot shift. Clin Orthop Relat Res, 2012, 470(3): 815-823.
11. Ellingson CI, Kurtz CA, Sekiya JK. Non surgical management of lateral side injuries of the knee. Spors Med Arthrosc, 2006, 14(1): 20-22.
12. Gardner MJ, Yacoubian S, Geller D, et al. The incidence of soft tissue injury in operative tibial plateau fractures: a magnetic resonance imaging analysis of 103 patients. J Orthop Trauma, 2005, 19(2): 79-84.
13. Sekiya JK, Kurtz CA. Posterolateral corner reconstruction of the knee: surgical technique utilizing a bifid Achilles tendon allograft and a double femoral tunnel. Arthroscopy, 2005, 21(11): 1400.
14. Feng H, Hong L, Geng XS, et al. Posterolateral sling reconstruction of the popliteus tendon: an all-arthrescopic technique. Arthroscopy, 2009, 25(7): 800-805．.
15. Kim SJ, Kim TW, Kim SG, et al. Clinical comparisons of the anatomical reconstruction and modified biceps rerouting technique for chronic posterolateral instability combined with posterior cruciate ligament reconstruction. J Bone Joint Surg (Am), 2011, 93(9): 809-818．.
16. Levy BA, Dajani KA, Morgan JA, et al. Repair versus reconstruction of the fibular collateral ligament and posterolateral corner in the multiligament-injured knee. Am J Sports Med, 2010, 38(4): 804-809.
17. LaPrade RF, Johansen S, Agel J, et al. Outcomes of all anatomic posterolateral knee reconstruction. J Bone Joint Surg (Am), 2010, 92(1): 16-22.
18. 张辉, 洪雷, 王雪松, 等. 膝关节创伤性多发韧带损伤中后外复合体重建的临床疗效. 中华创伤骨科杂志, 2010, 12(4): 308-313．.

《中国修复重建外科杂志》

膝关节多发韧带损伤中后外侧复合体的解剖重建

摘要 全文 图表 视频 参考文献 施引文献 补充材料

上一篇

下一篇

Format

Content

《中国修复重建外科杂志》

膝关节多发韧带损伤中后外侧复合体的解剖重建

摘要 全文 图表 视频 参考文献 施引文献 补充材料

上一篇

下一篇

Format

Content

摘要全文图表视频参考文献施引文献补充材料