目的:探讨联合应用前交叉韧带重建及前外侧韧带重建术治疗合并膝关节高度轴移的前交叉韧带损伤的有效性.方法:2015年5月至2016年4月,共156例患者诊断为前交叉韧带损伤,于我科接受同一医生手术治疗,其中22例高度轴移患者入选本研究.采用KT-1000检查膝关节前向稳定性,采用轴移试验评估膝关节旋转稳定性,使用Lysholm主观功能评分评估膝关节功能.结果:22例患者中男性14例,女性8例,平均年龄29.3岁(15 ～43岁),平均随访时间8.6个月(3～15个月).术前KT-1000测量,患侧-健侧差值平均为8.9±3.1 mm(4～16 mm),术后随访时侧-侧差值平均为2.1±0.6 mm(0～3mm),较术前显著改善(P＜0.01).术前轴移检查,20例患者轴移试验2+,2例患者3+.术后即刻检查轴移试验均为阴性.术后随访时,21例患者轴移试验阴性,1例患者1+,与术前相比有显著差异(P＜0.01).患者术前Lysholm评分平均为60.5±12.3(35～90),术后为79.2±7.8(66～90),有显著改善(P＜0.05).结论:前交叉韧带损伤合并高度轴移的患者,联合应用前交叉韧带重建及前外侧韧带重建术可有效恢复膝关节旋转稳定性,术后早期随访结果显示患者膝关节稳定性及功能评分满意.%Objective To evaluate the effectiveness of anterior cruciate ligament (ACL) reconstruction combined with anterolateral ligament(ALL)reconstruction in ACL injury patients with high-grade pivot shift.Methods From May 2015 to April 2016,156 patients underwent ACL reconstruction by the same surgeon,and 22 of them with grade 2/3 pivot shift were included in this study.Anteroposterior knee stability was evaluated using KT1000 measurement,and the rotatory stability was assessed using the pivot-shift test.The Lysholm score was used to monitor the clinical function.Results There were 14 male subjects and 8 females,with an average age of 29.3 years.The mean follow-up period was 8.6 months.The mean side-to-side difference of anteroposterior knee laxity was 2.1 ± 0.6 mm,significantly improved compared with the preoperative 8.9 ± 3.1 mm.The preoperative pivot-shift indicated 2+ in 20 patients and 3+ in 2 patients,while at the final follow-up,21 patients had negative pivot shift with 1 of 1+ pivot shift.The difference was significant.The average Lysholm score improved significantly from 60.5 ± 12.3 preoperatively to 79.2 ± 7.8 at the final follow-up.Conclusion The rotatory instability can be effectively restored through the ACL reconstruction combined with ALL reconstruction in patients with high-grade pivot shift.The early-stage knee stability and functional outcomes indicate significant improvement postoperatively.
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