摘要
目的探讨膝关节脱位的治疗策略及临床疗效。方法对单侧膝关节脱位36例进行回顾性分析，男22例，女14例，年龄19-72岁，平均35岁。按改良Sehenck膝关节脱位分型，急性膝关节脱位30例，其中KD-Ⅰ型7例（X线表现为旋转型膝关节脱位）、KD-Ⅲ型23例；陈旧性膝关节脱位6例，均为KD-Ⅲ型。KD-Ⅰ型急性膝关节脱位7例、KD—Ⅲ型陈旧性膝关节脱位6例均行一期关节镜下十字韧带重建术＋侧副韧带重建或修复术。KD-Ⅲ型急性膝关节脱位23例中2例高龄患者采用手法复位及石膏固定；18例采用分期手术，先修复或重建侧副韧带，3周后再重建十字韧带；3例合并血管、神经损伤者行一期十字韧带重建术＋侧副韧带重建或修复术。末次随访时行膝关节临床检查和功能评估。结果全部病例随访18-36个月，平均27个月。末次随访时Lysholm膝关节评分（82．0±11．4）分，Tegner膝关节运动水平评分（5．5±1．3）分，关节活动度118．3°±19．2°，与术前比较均有改善（P〈0．01）。8例（23．5％，8／34）残留膝关节不稳定：Sag征阳性和后抽屉试验（＋＋）-（＋＋＋）8例，外翻应力试验（＋＋）1例，内翻应力试验（＋＋＋）1例。结论对KD—Ⅰ型急性膝关节脱位和KD-Ⅲ型陈旧性膝关节脱位可采用关节镜下一期手术；对KD-Ⅲ型急性膝关节脱位可采用分期手术，以降低术后关节僵硬的风险。
Objective To discuss the treatment strategy of knee dislocation and to evaluate its outcome. Methods Thirty-six patients with unilateral knee dislocation treated with individualized protocol were studied retrospectively, including 22 males and 14 females with an average age of 35 years （range, 19- 72 years）. There were 30 acute and 6 chronic knee dislocations. According to the modified Schenck＇s classification of knee dislocation, there were 7 KD-Ⅰ and 23 KD-Ⅲ cases in the acute category, and all 6 chronic cases were KD-Ⅲ. Seven acute KD-Ⅰ and 6 chronic KD-Ⅲ cases underwent one-stage arthroscopic surgery. In 23 acute KD-Ⅲ cases, 2 were treated conservatively with splint or brace due to advanced age, 18 with staged surgery, 3 with one-stage surgery due to concomitant vascular and nerve injury. Functional and clini- cal evaluation was conducted at final follow-up. Results All 36 patients were followed up for an average of 27 months （range, 18-36 months）. The Lysholm score （82.0±11.4）, Tegner score （5.5±1.3）, and knee range of motion （118.3°±19.2°） at final follow-up showed a statistically significant improvement compared with preoperative results （P〈0.01）. Eight （23.5%） patients had residual knee instability： posterior drawer test and Sag sign were positive （＋＋ or ＋＋＋） in 8 knees, valgus instability （＋＋） in 1 and varus instability （＋＋＋） in 1. The remaining 28 knees were stable. Conclusion Special attention should be paid to rotational knee dislocation with single cruciate ligament rupture. Properly individualized treatment plan is the key to optimal outcome. Arthroscopic surgery can lead to successful outcome. Early one-stage arthroscopic surgery is recommended for acute KD- Ⅰ and chronic KD-Ⅲ dislocation, staged arthroscopic surgery for acute KD-Ⅲ dislocation.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2012年第6期545-550,共6页
Chinese Journal of Orthopaedics
关键词
膝脱位
韧带
创伤和损伤
关节镜检查
Knee dislocation
Ligament
Wound and injuries
Arthroscopy
