Abstract:

Objective　To explore the short-term clinical outcome of one-stage arthroscopically assisted anterior，posterior and lateral collateral ligament reconstruction and medial collateral ligament（MCL） repair in multiligament knee injuries（MKI），aiming to provide a reference for clinical diagnosis and treatment of this disease.Methods　Totaled 29 cases of MKI（type KD Ⅱ-Ⅳ by Schenck classification） were included from the First Affiliated Hospital of Guangxi Medical University from December 2011 to July 2014.All of them were treated by one-stage arthroscopic surgery：under general anesthesia，arthroscopic examination and debridement were performed through both the medial and lateral approaches；the anterior cruciate ligament（ACL） was reconstructed with the hamstring tendon of the contralateral knee，the posterior cruciate ligament（PCL） and lateral collateral ligament（LCL） were reconstructed with the allogeneic tendon，and the MCL was repaired by suture anchors.In addition，all the cases received individualized rehabilitation trainings.The indicators for evaluating the short-term outcome include postoperative incidence of complications，follow-up results，anterior drawer test（ADT），posterior drawer test（PDT），Bohler sign，Lysholm knee score，IKDC score and range of motion.Results　All the cases were followed up for a mean of（18.5±5.4）（range，12-36） months.During which，the surgical incision of all cases healed by first intention，without infection，osteofascial compartment syndrome，vascular nerve injury associated with surgery or other complications；good range of motion，and good anterior-posterior-lateral stability of the knee were achieved in all cases（as of the last follow-up）.Although postoperative knee joint adhesions occurred in 2 cases，normal range of motion was achieved in 1 after standardized rehabilitation training，and was also achieved in other 1 who was unresponsive to a 3-month rehabilitation training but then received the arthroscopic knee adhesions lysis.Positive results of ADT，PDT and Bohler sign at baseline became negative，and Lysholm knee score，IKDC score and range of motion at baseline were all improved significantly as of the last follow-up（P<0.05）．Conclusion　For MKI，using one-stage arthroscopic surgery to reconstruct both ACL ，PCL and LCL and to repair the MCL can achieve good stability of the knee and significantly improved knee function.

Key words: Knee；Ligaments, articular；Reconstructive surgical procedures；Treatment outcome

摘要： 目的　分析一期关节镜下重建修复膝关节多韧带损伤的临床疗效，以期为临床诊治提供指导。方法　选取2011年12月—2014年7月广西医科大学第一附属医院收治的膝关节多韧带损伤患者29例（Schenck分型：KD Ⅱ~Ⅳ型）。采用全身麻醉，从膝关节内、外侧入路进行关节镜镜检及清理，取对侧膝腘绳肌腱进行前交叉韧带（ACL）重建，采用异体肌腱行后交叉韧带（PCL）、外侧副韧带（LCL）重建，内侧副韧带（MCL）行带线锚钉修复，并进行个体化康复功能锻炼。记录手术并发症、随访结果，比较术前、末次随访患者的前、后抽屉试验、侧方应力试验、Lysholm评分、国际膝关节文献委员会膝关节评估表（IKDC）评分和关节屈伸活动范围。结果　患者术后切口均Ⅰ期愈合，无感染、骨筋膜室综合征、手术相关血管神经损伤等并发症发生。患者均获得随访，随访时间12~36个月，平均随访时间为（18.5±5.4）个月。29例患者末次随访关节活动功能良好，前后及侧方稳定性良好，其中2例术后随访期间出现膝关节粘连，经过正规康复锻炼后，1例患者恢复到正常活动范围，另1例连续进行3个月功能锻炼后关节活动范围未有改善，接受了关节镜下膝关节粘连松解术，术后膝关节活动范围恢复正常。患者术前前、后抽屉试验及侧方应力试验均为阳性，末次随访前、后抽屉试验、侧方应力试验均为阴性。患者术前Lysholm评分、IKDC评分和关节活动度低于末次随访（P<0.05）。结论　关节镜下一期重建ACL、PCL，同期重建修复副韧带，术后可恢复膝关节多韧带损伤稳定性，改善膝关节功能。

关键词: 膝关节；韧带, 关节；修复外科手术；治疗结果