膝关节后交叉韧带合并后外侧角损伤
后交叉韧带,,膝关节；,后交叉韧带；,四股腘绳肌腱；,膝后外侧角；,股二头肌腱；,关节镜,1临床资料与方法,2结果,3讨论,参考文献：
摘 要：[目的]探索膝关节后交叉韧带(PCL)合并后外侧角(PLC)损伤的临床特征，评估同期关节镜下四股腘绳肌腱单束重建膝PCL和后1/2股二头肌腱重建PLC的技术和效果。[方法]自2001年12月~2004年12月，14例病人(14膝)重度膝关节不稳入住本科，均表现为3+后抽屉试验阳性，内翻试验阳性，外旋试验患膝较健侧>10°，关节镜检查证实为PCL断裂，膝后外侧间隙张开，外侧半月板抬高，腘肌腱断裂。2例伴腓总神经损伤。均于关节镜下行自体四股腘绳肌腱单束PCL重建术，后侧1/2股二头肌腱PLC重建术。[结果]本组术后早期均未发生严重并发症。14例均获得随访，随访时间12~33个月，平均(2114±726)个月。膝关节后侧稳定性有非常明显进步。膝关节伸直位、屈曲30°位内翻试验均为阴性。膝关节屈曲30°、90°位外旋试验双侧差均<10°。Lysholm膝关节功能评分为70~95分，平均(8679±723)分，较术前(40~60)分，平均(4714±825)分)明显改进(P<001)。IKDC综合评定正常(A级)4膝、接近正常(B级)9膝、异常(C级)1膝，较术前[异常(C 级)3膝、显著异常(D级)11膝]有非常明显的改进(Z=3296，P<0001)。14例患者中，12例恢复伤前运动水平，2例运动水平较伤前减低。 [结论] PCL损伤常合并PLC损伤，表现为重度后侧不稳和后外侧旋转不稳。关节镜下单束重建膝PCL，同期后侧1/2股二头肌腱重建PLC，手术损伤小、术后膝关节功能恢复满意。关键词：膝关节； 后交叉韧带； 四股腘绳肌腱； 膝后外侧角； 股二头肌腱； 关节镜
Abstract：[Objective]To explore the clinical characteristic of combined posterior cruciate ligament (PCL) with posterolateral corner (PLC) injuries,and evaluate the technique and outcome of arthroscopic single bundle reconstruction of PCL and reconstruction of PLC with posterior half of biceps femoris tendon[Method]From Dec. 2001 to Dec. 2004,14 patients (14 knees) with severe posterior and posterolateral rotatory instability were treated surgically in our department,all of them presented III degree positive results of posterior drawer test,positive varus stress test and more than 10 degree of external rotation of the affected knees compared with the intact kneesPCL tear and abnormal opening of posterolateral compartment were seen in all of the 14 knees under arthroscopyOf them,2 knee were combined with common peroneal nerve injuryAll the damaged PCLs were reconstructed with single bundle of autogenous quadrupled hamstring tendons under arthroscopy,and PLCs were reconstructed with the posterior half of biceps femoris tendon tenodesis[Result]No severe complications occurred in early stage after operation in the 14 patientsAll of them were followed up from 12 to 33 months with an average of 2114±726 monthsPosterior stabilities were recovered significantly,varus stress test was negative at 30 degree of flexion and full extension,less than 10 degree of external rotation compared with the intact knee in all of the patientsLysholm score was remarkable improved from 40~60 (mean 471±825) preoperatively to 70~95 ( mean 8679±723) at follow up(P<00001)Furthermore,there was a significant improvement in IKDC score from abnormal (grade C) in 3 knees and severely abnormal ( grade D ) in 11 knee preoperatively to normal ( grade A) in 4 knees,nearly normal ( grade B ) in 9 knees and abnormal in 1 knee at follow up(P=00000)Of the 14 patients,12 patients returned to the same preinjury sports level and 2 were under the level[Conclusion]PCL combined with PLC injuries displays severe posterior and posterolateral rotatory instabilitiesConcomitant arthroscopic single bundle PCL reconstruction with autogenous quadrupled hamstring tendons and PLC reconstruction with posterior half of biceps femoris tendon tenodesis are recommended alternatively with advantages of miniinvasion and reliable outcome ......
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