内侧副韧带Ⅲ度损伤合并前交叉韧带损伤的治疗选择

摘要

Objective To compare the clinical efficacy of different treatments for injuries of medial collateral ligament (MCL) Ⅲgrade and anterior cruciate ligament (ACL). Methods Forty-six patients with MCLⅢgrade and ACL injuries admitted to Dalian Central Hospital from June 2013 to April 2017 were retrospectively analyzed, including 28 males and 18 females. Sixteen patients underwent arthroscopic reconstruction of the ACL, and medial collateral ligament was repaired with two anchors simultaneously in 2 weeks (group A); 15 patients were treated with reconstruction of the ACL in 2 weeks, and 4 times extracorporeal shock wave therapies were performed 2 weeks after surgery (group B); 15 patients were treated with reconstruction of the ACL in 2 weeks, and fixed with external fixation (group C). Patients were assessed in 3 months, 6 months and 12 months after surgery, and the Lysholm knee function score, the international knee documentation committee knee evaluation form (IKDC) score and the knee joint range of motion (ROM) were recorded. Results Three months after operation, the levels of Lysholm scores, IKDC scores and ROM in three groups were significantly improved compared with those before operation (P < 0.05). The IKDC scores and Lysholm scores in both group A and group B [IKDC score: (51.8 ± 3.1), (49.7 ± 3.9) scores; Lysholm score: (70.3 ± 3.7), (69.5 ± 3.4) scores] were better than those in group C [(44.5 ± 3.4), (59.3 ± 4.7) scores], and there were significant differences (P<0.05). Six months and 12 months after operation, the IKDC score, Lysholm score and the knee joint ROM in group A were better than those in group B and group C (P<0.05). Conclusions For knee joint MCLⅢgrade combined with ACL injuries, surgical treatment will obtain better functional scores and activity, and the effect of conservative treatment of MCL injury with extracorporeal shock wave therapy is not good.%目的 比较前交叉韧带(ACL)损伤合并内侧副韧带(MCL)Ⅲ度损伤不同治疗方式的临床疗效.方法 回顾性分析大连市中心医院2013年6月至2017年4月收治的46例急性Ⅲ度MCL损伤合并ACL损伤的患者,男28例,女18例.16例患者伤后2周内行ACL重建+MCL缝合带线铆钉内固定作为A组,15例患者伤后2周内单纯行ACL重建并支具固定,术后2周后行4次体外冲击波(ESW)治疗,作为B组,15例患者伤后2周内单纯行ACL重建并支具固定,作为C组.分别在术后3、6、12个月对三组患者进行评估,分别记录国际膝关节文献委员会膝关节评估表(IKDC)评分、Lysholm评分及膝关节活动度(ROM)情况.结果 术后随访3个月时,三组患者Lysholm评分、IKDC评分及ROM均较术前有明显改善,差异有统计学意义(P＜0.05),A、B两组患者的IKDC评分[(51.8 ± 3.1)、(49.7 ± 3.9)分]及Lysholm评分[(70.3 ± 3.7)、(69.5 ± 3.4)分]优于C组[(44.5 ± 3.4)、(59.3 ± 4.7)分],差异有统计学意义(P＜0.05);术后随访6个月及12个月时,A组IKDC评分、Lysholm评分及膝关节活动度均优于B、C两组,差异有统计学意义(P＜0.05).结论 急性ACL损伤合并MCLⅢ度损伤早期手术会获得更好的功能评分及活动度,对于保守治疗的MCL损伤ESW治疗的效果欠佳.