难复性膝关节脱位的手术治疗△（开放获取）

Surgical techniques for irreducible knee dislocation

摘要:

[目的]介绍难复性膝关节脱位（irreducible knee dislocation, IKD）的手术技术及其初步临床结果。[方法]2015 年 1 月—2023 年 12 月，对 3 例难复性膝关节脱位患者实施一期开放复位二期镜下交叉韧带重建手术。在一期手术中，首先尝试手法复位，手法复位失败后切开内侧，暴露内侧副韧带、内侧支持带及 Stieda 骨折，复位内侧结构后复位膝关节。于股骨内侧髁置入 2 枚锚钉，将内侧副韧带、内侧支持带及 Stieda 骨折固定在内侧股骨髁，同侧自体半腱肌重建增强内侧结构。康复后二期行前后交叉韧带重建，先建立后交叉韧带隧道再建立前交叉韧带骨隧道，使用对侧的自体腘绳肌腱重建前交叉韧带，而 PCL 则使用人工韧带 （LARS） 重建。[结果] 3 例患者均顺利完成手术且无严重并发症。随访 12~20 个月，平均 （15.5 ±3.3） 个月。 患者 Lysholm 评分由术前的 （47.0±1.3） 分提升至末次随访时 （86.3±1.8） 分 （P＜0.05），IKDC2000 评分由术前的 （48.1±1.8） 分提升至末次随访时 （85.0±1.2） 分 （P＜0.05），KSS 评分由术前的 （45.0±1.5） 分提升至末次随访时 （88.0±1.1） 分 （P＜ 0.05），双膝内侧关节间隙宽度由术前的 （12.3±2.2） mm 提升至末次随访时 （1.7±0.8） mm （P＜0.05）。末次随访时 3 例患者轴移试验均（-），存在轻度前后向不稳，前抽屉试验（-）、后抽屉试验（+）。MRI 确认膝关节隧道位置无误。[结论]分期手术治疗 IKD 对膝关节稳定性和功能有较好的疗效。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical results of surgical treatment for the irreducible knee dislocation (IKD). [Methods] From January 2015 to December 2023, 3 patients received first stage open reduction and second stage arthroscopic cruciate ligament reconstruction for IKD. In the first stage of surgery, manual reduction was initially attempted. If manual reduction failed, the medial side of the knee was incised to expose the medial collateral ligament, medial retinaculum, and Stieda fracture. After releasing the locked medial structures, the knee was reduced properly. As two anchors were placed on the medial femoral condyle, and the medial collateral ligament, medial retinaculum, and Stieda fracture were fixed to the medial femoral condyle. The ipsilateral semitendinosus tendon autograft could be used to reconstruct or augment the medial structures if necessary. After rehabilitation during the interval between the two-stage operations, arthroscopic ACL and PCL reconstructions were conducted in the second stage. The bone tunnels for PCL were created first, followed by those for ACL. Finally, the ACL was reconstructed by using contralateral hamstring tendons, while the PCL was reconstructed by an artificial ligament graft (LARS). [Results] All three patients had two-stage operations performed successfully without severe complications. Follow-up periods ranged from 12 to 20 months, with an average of (15.5 ± 3.3) months. Lysholm score increased from (47.0±1.3) preoperatively to (86.3±1.8) at the last follow-up (P＜0.05), IKDC2000 score increased from (48.1±1.8) to (85.0±1.2) (P＜ 0.05), KSS score from (45.0±1.5) to (88.0±1.1) (P＜0.05), and medial joint space width from (12.3±2.2) mm to (1.7±0.8) mm accordingly (P＜ 0.05). At the last follow-up, all 3 patients had mild anterior-posterior instability with axial shift test (-), anterio drawer test (-) and posterio drawer test (+). MRI confirmed the proper location of the bone tunnels. [Conclusion] The staged surgical treatment for IKD demonstrates satisfactory outcomes in terms of knee stability and functional recovery.