本文選題：膝關(guān)節(jié) + 脫位��； 參考：《中國運動醫(yī)學雜志》2016年12期

【摘要】：目的:探討關(guān)節(jié)鏡輔助治療難復性膝關(guān)節(jié)后外側(cè)脫位的臨床療效。方法:2009年1月至2014年5月,采用關(guān)節(jié)鏡輔助治療難復性膝關(guān)節(jié)后外側(cè)脫位并隨訪2年以上患者13例,男8例,女5例;年齡27~56歲,平均37.8歲。受傷至手術(shù)時間1~3天,平均1.84天。所有患者于關(guān)節(jié)鏡下復位后,一期重建前后交叉韌帶并修復或重建損傷的內(nèi)外側(cè)副韌帶。術(shù)后膝關(guān)節(jié)穩(wěn)定性評價采用體格檢查、KT-1000和Telos應力像,后兩者測量結(jié)果根據(jù)IKDC膝關(guān)節(jié)檢查表進行分類(正常、接近正常、異常和嚴重異常);患者臨床功能評價采用IKDC評分、Lysholm評分、Tegner評分和滿意率。結(jié)果:隨訪時間為24~56個月,平均32.6個月。末次隨訪時,患者膝關(guān)節(jié)活動度為2.69°±5.63°~132.69°±11.66°。Lachman試驗和軸移試驗均陰性12例,均1+陽性1例;后抽屜試驗陰性11例,1+陽性2例;屈膝30°位內(nèi)翻應力試驗陰性13例;屈膝30°位外翻應力試驗陰性11例,1+陽性1例,2+陽性1例。KT-1000示患者膝關(guān)節(jié)前后向總位移和單純前移的側(cè)-側(cè)差值分別為2.15±1.57 mm和1.61±0.86 mm。Telos應力像示術(shù)后前移側(cè)-側(cè)差值為2.23±0.92 mm,后移為3.23±1.16 mm,內(nèi)側(cè)間隙為1.77±1.87 mm,外側(cè)間隙為0.46±0.52 mm�；颊咝g(shù)前IKDC評分、Lysholm評分和Tegner評分分別為11.13±2.27分、1.31±2.59分和0.00±0.00分,術(shù)后分別為79.76±8.33分、84.53±6.39分和5.07±1.26分,術(shù)前術(shù)后臨床功能評分差異均有統(tǒng)計學意義(t=27.02,P=0.001;t=45.72,P=0.001;t=14.58,P=0.001)。其中10例患者對術(shù)后臨床療效表示滿意或非常滿意,滿意率為76.9%。多重線性回歸示患者體重指數(shù)與術(shù)后臨床療效的相關(guān)性有統(tǒng)計學意義(t=-4.21,P=0.001)。結(jié)論:采用關(guān)節(jié)鏡輔助治療難復性膝關(guān)節(jié)后外側(cè)脫位,一期重建前后交叉韌帶并修復或重建損傷的內(nèi)外側(cè)副韌帶,患者術(shù)后膝關(guān)節(jié)穩(wěn)定性和臨床功能較術(shù)前均有顯著改善,患者術(shù)后滿意率達76.9%。
[Abstract]:Objective: to investigate the clinical effect of arthroscopic adjuvant treatment of posterolateral dislocation of refractory knee joint.Methods: from January 2009 to May 2014, 13 patients (8 males and 5 females) with intractable posterolateral dislocation of the knee were treated with arthroscopy and followed up for more than 2 years, with an average age of 37.8 years (2756 years).The time from injury to operation was 1 to 3 days, with an average of 1.84 days.After arthroscopic reduction, the anterior and posterior cruciate ligaments were reconstructed and the injured internal and external collateral ligaments were repaired or reconstructed.After operation, the knee joint stability was evaluated by physical examination KT-1000 and Telos stress images. The results of the latter two measurements were classified according to the IKDC knee joint examination table (normal, close to normal).IKDC score and Lysholm score and Tegner score and satisfaction rate were used to evaluate the clinical function of the patients.Results: the follow-up time was 24 ~ 56 months (mean 32.6 months).At the last follow-up, the range of motion of knee joint was 2.69 擄鹵5.63 擄鹵132.69 擄鹵11.66 擄. Lachman test and axial shift test were all negative in 12 cases, all of them were positive in 1 case, 11 cases were negative in posterior drawer test, 13 cases were negative in flexion 30 擄varus stress test.Lateral displacement of knee joint was 2.15 鹵1. 57mm and 1. 61 鹵0. 86 mm.Telos stress imaging showed that the lateral-lateral difference of knee joint displacement was 2. 15 鹵1. 57mm and 1. 61 鹵0. 86 mm.Telos stress imaging showed that the lateral-lateral difference of knee joint total displacement and simple forward displacement were 2. 15 鹵1. 57mm and 1. 61 鹵0. 86 mm.Telos respectively2.23 鹵0.92 mm, 3.23 鹵1.16 mm, 1.77 鹵1.87 mm in medial space and 0.46 鹵0.52 mm in lateral space.Among them, 10 cases were satisfied or very satisfied with the clinical effect after operation, the satisfaction rate was 76. 9%.Multiple linear regression analysis showed that the correlation between body mass index (BMI) and postoperative clinical efficacy was statistically significant.Conclusion: arthroscopic adjuvant treatment of posterolateral dislocation of the refractory knee joint, primary reconstruction of anterior and posterior cruciate ligaments and repair or reconstruction of the injured internal and external collateral ligaments, the stability and clinical function of the knee joint after operation were significantly improved compared with those before operation.The satisfaction rate of the patients was 76. 9%.
【作者單位】： 廈門大學附屬福州第二醫(yī)院運動損傷科;
【基金】：福建省自然科學基金項目(2016J01481)
【分類號】：R687.4

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