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摘要 目的 评价比较一期和二期修复重建膝关节脱位合并多发韧带损伤的临床疗效及其预后的影响因素。方法 回顾性分析2015年1月至2020年1月中南大学湘雅医学院附属海口医院收治的23例膝关节脱位患者资料,包括膝关节脱位(knee dislocation,KD)-Ⅱ型2例,KD-Ⅲ(M)型13例,KD-Ⅲ(L)型5例,KD-Ⅳ型3例。其中17例行关节镜辅助下一期修复重建多发韧带损伤治疗,男12例,女5例;年龄19~51岁,平均(31.38±15.04)岁;右膝11例,左膝6例。6例行二期修复重建多发韧带损伤治疗,男4例,女2例;年龄12~55岁,平均(32.82±9.65)岁;右膝4例,左膝2例。术后3、6、12个月随访行临床膝关节稳定性、活动度检查、X线检查及MRI检查,采用Lysholm评分进行主观评估、国际膝关节文献委员会膝关节评估表(the international knee documentation committee knee evaluation form,IKDC)综合评估膝关节恢复情况,记录结果并比较两组临床资料和预后,采用Fisher确切概率法分析患者性别、年龄、受伤因素、损伤类型、手术方式、手术间隔时间各单因素对手术预后的影响。结果 23例患者术后均获随访,随访时间12~18个月,平均(14.09±4.27)个月。术后切口均甲级愈合,无切口感染、关节内血肿并发症发生,一期手术组和二期手术组术后3个月发生膝关节黏连各1例。末次随访时下肢力线正常,膝关节内外侧和前后向稳定性恢复。末次随访时一期修复重建组患者Lysholm评分(83.06±4.99)分、IKDC评分(81.00±3.35)分,与二期重建组患者Lysholm评分(83.67±3.77)分、IKDC评分(79.76±4.34)分比较差异无统计学意义(P>0.05)。一期修复重建组患者膝关节屈曲活动度(118.24±11.71) °,与二期重建组患者膝关节屈曲活动度(120.67±8.38) °比较差异无统计学意义(P>0.05)。单因素中对性别、一期手术年龄、受伤机制、合并肌间静脉血栓、损伤分型、手术方式、分期手术间隔时间等影响因素分别进行组间比较,差异无统计学意义(P>0.05),说明这些影响因素对手术预后没有影响。但是在二期手术组中6例患者术后膝关节功能恢复优良者年龄(30.00±7.07)岁,明显低于恢复可差者年龄(54.00±9.13)岁,年龄因素差异在二期手术中具有统计学意义(t=-3.2,P<0.05)。结论 关节镜辅助下一期修复重建和二期重建治疗膝关节脱位合并多发韧带损伤均可获得较好的临床疗效,年龄是影响二期手术预后的危险因素。
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关键词 :
膝关节脱位,
多发韧带损伤,
修复,
重建,
关节镜
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通讯作者:
金旭红
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作者简介: 卓泽铭(1986- ),男,主治医师,中南大学湘雅医学院附属海口医院骨科医学中心,66215103@qq.com |
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