膝關節多發韌帶損傷中后外側復合體的解剖重建_《中國修復重建外科雜志》

作者：

張東亮 , 王磊 , 曹建剛 , 劉軍

天津市人民醫院暨南開大學人民醫院關節外科（天津，300121）;

關鍵詞：

膝關節后外側復合體多發韌帶損傷解剖重建

DOI：

10.7507/1002-1892.20130101

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目的探討膝關節多發韌帶損傷中后外側復合體（posterolateral complex，PLC）解剖重建的方法及近期療效。方法2007年6月－2011年7月，收治23例膝關節多發韌帶損傷患者。男15例，女8例；年齡19～56歲，平均41歲。交通事故傷9例，扭傷7例，砸傷3例，高處墜落傷4例。損傷至手術時間13～78 d，平均32 d。患者后抽屜試驗及Lachman試驗均呈陽性，均伴內翻、外旋不穩。膝關節Lysholm評分為（43.4 ± 5.7）分。國際膝關節文獻委員會（IKDC）綜合評分均為D級。PLC損傷根據Fanelli分型標準，均為C型。X線片檢查示，后方應力下脛骨后移（13.3 ± 4.2）mm，內翻應力下外側關節間隙張開（15.1 ± 2.4）mm。術中取自體同側/對側半腱肌、股薄肌肌腱，必要時聯合同種異體肌腱，關節鏡下重建前、后交叉韌帶，并聯合后外側切口行PLC靜力性解剖重建。結果術后切口均Ⅰ期愈合，無相關并發癥發生。患者均獲隨訪，隨訪時間12～56個月，平均28個月。末次隨訪時，患者后抽屜試驗及Lachman試驗均呈陰性， 3例內翻不穩，2例外旋不穩。膝關節Lysholm評分為（85.6 ± 16.7）分，與術前比較差異有統計學意義（t=11.469，P=0.000）。IKDC綜合評分：A級7例，B級12例，C級4例；與術前比較差異有統計學意義（Z=4.285，P=0.000）。X線片檢查示，后方應力下脛骨后移（5.1 ± 4.4）mm，內翻應力下外側關節間隙張開（3.2 ± 2.8）mm，與術前比較差異均有統計學意義（P lt; 0.05）。結論在膝關節多發韌帶損傷的治療中，應用自體腘繩肌肌腱，必要時聯合同種異體肌腱解剖重建PLC，可獲得較好近期療效。

引用本文： 張東亮,王磊,曹建剛,劉軍. 膝關節多發韌帶損傷中后外側復合體的解剖重建. 中國修復重建外科雜志, 2013, 27(4): 436-439. doi: 10.7507/1002-1892.20130101 復制

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.	趙金忠. 膝關節重建外科學. 鄭州: 河南科學技術出版社, 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.	張輝, 洪雷, 王雪松, 等. 膝關節創傷性多發韌帶損傷中后外復合體重建的臨床療效. 中華創傷骨科雜志, 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. 趙金忠. 膝關節重建外科學. 鄭州: 河南科學技術出版社, 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. 張輝, 洪雷, 王雪松, 等. 膝關節創傷性多發韌帶損傷中后外復合體重建的臨床療效. 中華創傷骨科雜志, 2010, 12(4): 308-313．.

《中國修復重建外科雜志》

膝關節多發韌帶損傷中后外側復合體的解剖重建

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《中國修復重建外科雜志》

膝關節多發韌帶損傷中后外側復合體的解剖重建

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