关节镜辅助一期自体肌腱重建KD-Ⅲ-MC型多发韧带损伤临床观察

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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.

Key words： knee dislocation arthroscopy autogenous tendon KD-Ⅲ-MC type

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	Li Shuai 1
	li Yuji 2*
	Chang Xudong 2
	et al

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Li Shuai 1,li Yuji 2*,Chang Xudong 2, et al. Clinical Observation of Multiple Ligament Injuries of Medial Rotatory Ddislocation with Autogenous Tendon Reconstruction Assisted by Arthroscopy in The First Stage[J]. sygkzz, 2020, 26(2): 118-123.

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http://www.sygkzz.com/EN/ OR http://www.sygkzz.com/EN/Y2020/V26/I2/118

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[1]	. [J]. sygkzz, 2021, 27(4): 359-362.