膝关节镜下双后内侧入路重建后交叉韧带的近期疗效

摘要

Objective To investigate the short-term clinical efficacy of arthroscopic reconstruction of posterior cruciate ligament (PCL) via double posteromedial portals.Methods A retrospective case series study was performed on the clinical data of 29 patients with PCL injury from January 2013 to January 2018 admitted to Xuancheng People's Hospital of Anhui province.There were 15 males and 14 females,with an average age of 49.6 years (range,27-61 years).There were 13 patients with left knee injury and 16 patients with right knee injury.The combined injuries included five patients with medial meniscus tear,seven patients with lateral meniscus tear,one patient with medial collateral ligament injury,and two patients with lateral medial collateral ligament injury.The average duration from injury to surgery was 14.1 days (range,5-97 days).All patients received arthroscopic PCL reconstruction surgery using double posteromedial portals.The operation time and intraoperative blood loss were recorded.The posterior drawer test,reverse Lachman test,posterior translation,and Lysholm knee score scale were used to evaluate knee function preoperatively and 6 months after operation.The complications were recorded.Results All patients were followed up for 6-22 months (mean,12 months).The operation time was (63.3 ±9.5) minutes,and the intraoperative blood loss was (48.9 ± 22.8)ml.The posterior drawer tests and reverse Lachman tests of all patients turned to be negative 6 months after surgery.Preoperatively,the posterior translation and Lysholm score were (11.2 ± 3.3)mm and (42.7 ± 12.2)points,respectively.At 6 months postoperatively,the posterior translation and Lysholm score were (2.2 ± 0.5) mm and (86.3 ± 9.0) points,respectively (P ＜ 0.05).No complication such as infection and neurovascular injury occured.Conclusion The technique of arthroscopic PCL reconstruction surgery using double posteromedial portals has the advantages of good knee joint stability,less tibial posterior translation,and fast function recovery with satisfactory short-term efficacy.%目的 探讨膝关节镜下双后内侧人路重建后交叉韧带(PCL)的近期疗效.方法 采用回顾性病例系列研究分析2013年1月一2018年1月安徽省宣城市人民医院收治的29例PCL损伤患者临床资料,其中男15例,女14例;年龄27 ～61岁,平均49.6岁.左膝13例,右膝16例.膝关节合并伤:内侧半月板损伤5例,外侧半月板损伤7例,内侧副韧带损伤l例,外侧副韧带损伤2例.受伤至手术时间5～97 d,平均14.1 d.手术采用双后内侧人路进行PCL重建.记录手术时间和术中出血量.比较术前、术后6个月患膝的后抽屉试验和后向Lachman试验结果、膝关节胫骨后移程度及Lysholm膝关节功能评分.观察并发症发生情况.结果 29例患者获随访6～22个月,平均12个月.手术时间为(63.3±9.5) min,术中出血量为(48.9±22.8) ml.术前患者后抽屉试验和后向Lachman试验均为阳性,术后6个月均为阴性.胫骨后移程度术前为(11.2±3.3)mm,术后6个月为(2.2±0.5)mm (P ＜0.05).Lysholm膝关节评分术前为(42.7±12.2)分,术后6个月为(86.3±9.0)分(P＜0.05).无一例患者发生术后感染或神经血管损伤等并发症.结论 膝关节镜下双后内侧入路重建PCL具有关节稳定性好、胫骨后移程度轻、功能恢复快等特点,近期疗效满意.