Clinical Observation of Multiple Ligament Injuries of Medial Rotatory Ddislocation with Autogenous Tendon Reconstruction Assisted by Arthroscopy in The First Stage
1.Graduate school of TCM Orthopaedics,Gansu university of traditional Chinese medicine
2.2nd Department of Joint,First Affiliated Hospital,Gansu University of Traditional Chinese Medicine
Abstract:Objective To evaluate the clinic outcome of KD-Ⅲ-MC multiple ligament injuries by using arthroscope assisting the with first period reconstruction of ligament and provide data aid for the treatment of multiple ligament of knee-joint.Methods According to the standard of Hua Xi Knee Dislocation and Multiple Ligament,32 KD-Ⅲ-MC examples were selected from in the Second Joint Department of 1st hospital of Gansu TCM Univ.from July 2015 to July 2018,which included 24 males and 8 females,with an average age of (35.42±7.86)years.The causes of injury were 14 cases of traffic accidents,8 cases of sprains,6 cases of smashing injuries,and 4 cases of fall injuries.The time from injury to operation was 14~21 days,with an average of (16.25±2.87) days.All patients had an international knee documentation committee (IKDC) score of grade D.The pre and post-drawer tests were ≥Ⅱ degrees,the Lachman test was Ⅲ degrees,the end point disappeared,and the medial collateral Ligament (MCL) injuries were classified as Grade Ⅱ or higher using the American Medical Association’s three-degree classification.X-ray examination of the Tilos stress site showed:forward stress tibial advance (8.15±3.46) mm,backward stress tibial advance (12.51±3.98) mm,and medial valgus stress medial gap (8.46±3.91) mm.Unilateral autologous tendons were taken under arthroscopy for single-beam reconstruction of the anterior and posterior cruciate ligaments during the same period of surgery.The medial structures were fixed with suture anchors and the capsular contraction was repaired if necessary.Results The incisions of all patients healed in one stage without infection;one case had deep vein thrombosis.All patients were followed up for 12 to 18 months,with an average of (14.18±2.45) months.At the last follow-up,all patients turned negative before and after the drawer test and Lachman test.Two patients had grade Ⅱ MCL injury and one had stiff knee.According to IKDC comprehensive score,there were 10 cases of grade A,16 cases of grade B,6 cases of grade C.Compared with preoperative,the difference was statistically significant (P<0.05).At the same time,patients with different injury types in the KD-Ⅲ-MC type were statistically grouped,and the Lysholm function score of the corresponding period was observed.As a result,the last knee Lysholm score was significantly different from that before surgery (P<0.05).There was no significant difference between the various types of injury before surgery (P>0.05).The Lysholm function score of the knee joint in the cartilage injury group was lower than that in the other groups after the last follow-up,indicating that poor recovery in the ligament injury group was related to articular cartilage injury.The Lysholm scores of the knees in all groups increased significantly at 3 months after surgery,and the differences were relatively large.The differences at 6 and 12 months after surgery were smaller than the 3 months after surgery.Conclusion In KD-Ⅲ-MC multiple ligament injury,a single bundle of autologous tendon which was used to reconstruct anterior cruciate ligament (ACL),posterior cruciate ligament (PCL) under arthroscope,with line anchor Nail fixation and enhanced sutures,joint capsule tightening and medial anatomical autogenous tendon reconstruction can achieve good short-term results.
[1]张东亮,王磊,曹建刚,等.膝关节多发韧带损伤中后外侧复合体的解剖重建[J].中国修复重建外科杂志,2013,27(4):436-439.
[2]Ferrari MB,Chahla J,Mitchell JJ,et al.Multiligament reconstruction of the knee in the setting of knee dislocation with a medial-sided injury[J].Arthrosc Tech,2017,6(2):341-350.
[3]许宏涛,董江涛,王娟,等.内侧副韧带合并前交叉韧带损伤的临床治疗策略[J].中国矫形外科杂志,2017,25(2):132-135.
[4]谢杰.一期和分期多组韧带重建术治疗外伤性膝关节脱位的临床效果比较[D].合肥:安徽医科大学,2017:18-21.
[5]史文骥,任强,毛宾尧.膝关节多发韧带伤关节镜下同期重建的疗效分析[J].中国内镜杂志,2019,25(7):17-21.
[6]焦强,张志强,杨自权,等.关节镜下一期人工韧带治疗膝关节多发韧带损伤[J].中国微创外科杂志,2018,18(8):732-735.
[7]高腾飞,夏斌,陈其亮,等.关节镜下一期LARS人工韧带重建术在多发膝关节韧带损伤修补中的应用[J].海南医学,2019,30(24):3178-3180.
[8]吴成,谢国庆,金文孝,等.关节镜下GraftLink技术重建联合带线锚钉固定治疗前交叉韧带合并内侧副韧带损伤[J].中国修复重建外科杂志,2019,33(6):685-688.
[9]崔胜宇,刘巍,朱新辉,等.使用同种异体肌腱修复重建膝关节多发韧带伤3~9年随访[J].实用骨科杂志,2017,23(2):124-127.
[10]Elkin JL,Zamora E,Gallo RA.Combined anterior cruciate ligament and medial collateral ligament knee injuries:anatomy,diagnosis,management recommendations,and return to sport[J].Curr Rev Musculoskelet Med,2019,12(2):239-244.
[11]张晓宇,安荣泽,王兆杰.膝关节后内侧结构损伤的研究进展[J].中国医药指南,2013,11(6):450-452.
[12]任海鹏,陈刚,蔡明.外伤性膝内侧副韧带损伤直接缝合与带线锚钉缝合比较分析[J].生物医学工程与临床,2019,23(4):422-426.
[13]黄华强,李箭,唐新.膝关节脱位后内侧结构及后外侧角损伤分期分型及诊治体系[J].中国修复重建外科杂志,2017,31(05):614-619.
[14]Svantesson E,Senorski EH,Alentorn-Geli E,et al.Increased risk of ACL revision with non-surgical treatment of a concomitant medial collateral ligament injury:a study on 19,457 patients from the Swedish National Knee Ligament Registry[J].Knee Surg Sports Traumatol Arthrosc,2019,27(8):2450-2459.
[15]Dale KM,Bailey JR,Moorman CT.Surgical Management and Treatment of the Anterior Cruciate Ligament/Medial Collateral Ligament Injured Knee[J].Clin Sports Med,2017,36(1):87-103.
[16]许宏涛.内侧副韧带损伤合并前交叉韧带损伤的临床治疗选择[D].河北医科大学,2018:9-15.
[17]Hongtao Xu,Kai Kang,Jian Zhang,et al.An anatomical-like triangular-vector ligament reconstruction for the medial collateral ligament and the posterior oblique ligament injury with single femoral tunnel:a retrospective study[J].J Orthop Surg Res,2017,12(1):3-9.