膝多韧带损伤一期修复重建策略与相关问题（开放获取）

Strategy and related problems on one-stage repair and reconstruction of knee multiligament injuries

摘要:

[目的] 评估一期多韧带修复重建术中的陷阱、术后的并发症，并进行对策分析。[方法] 回顾性分析 2011 年— 2024 年本院收治的 50 例多韧带合并伤患者的临床资料。统计术中陷阱、术后并发症的发生情况及处理对策。[结果] 排除丢失随访患者后共纳入 18 例。按受伤至手术时间间隔、手术涉及韧带的数量、是否伴膝关节脱位以及使用人工或自体移植物分别分层比较。早期组与延迟组、两韧带组与三韧带组、脱位组与未脱位组、人工腱组与自体腱组在术后 Lysholm、IKDC 和 VAS 评分的差异均无统计学意义（P＞0.05）。18 例中共 6 例发生并发症，并发症发生率为 33.3%。5 例术后膝关节僵硬，1 例经手法松解，4 例经康复锻炼后无不良后果。人工韧带组的关节僵硬率显著高于自体肌腱组（66.7% vs 8.3%, P=0.022），两条肌腱修复重建组的关节僵硬显著低于 3 条肌腱修复重建（0 vs 35.7%, P＜0.001）。[结论]一期多韧带重建术后最常见并发症是关节僵硬， 采用人工韧带，或三韧带一期重建更易出现早期关节僵硬。而早期及延迟手术、伤后脱位与否的临床结果无显著差异。

Abstract:

[Objective] To evaluate the pitfalls and postoperative complications in one-stage repair and reconstruction for multiple ligament injuries of the knee, and to analyze the countermeasures. [Methods] A retrospective study was conducted on 50 patients who had knee multiple ligament injuries treated surgically in our hospital from 2011 to 2024. The incidence of intraoperative traps and postoperative complications and their treatment were hierarchically analyzed. [Results] A total of 18 patients were included into this study after the patients who lose the follow-up were excluded. The patients were compared in stratifications based on time interval between injury and surgery, number of ligaments involved, whether the knee was dislocated at hospital admission, and artificial or autogenous grafts used. There were no significantly differences in terms of Lysholm, IKDC and VAS scores between the early operation group and delayed operation group, two ligaments involved group and three ligaments involved group, dislocation group and non-dislocation group, artificial ligament graft group and tendon autograft group (P＞0.05). Complications occurred in 6 of 18 cases (33.3%), including 5 cases of knee stiffness after operation, which resolved without adverse consequences after manual release in 1 case, and rehabilitation exercise in 4 cases. In term of stratified comparison, the artificial ligament group had significantly ankylosis ratio and the tendon autograft group (66.7% vs 8.3% , P= 0.022), whereas the two ligament involved group had significantly less ankylosis ratio than the three ligaments involved group (0 vs 35.7%, P＜0.001). [Conclusion] Ankylosis is the most common complication after one-stage repair and reconstruction for the multiple ligament injuries of the knee, which is more likely to occur after one-stage reconstruction with artificial ligament graft, or for three ligaments involved. There was no significant difference in clinical outcomes between early and delayed surgery and with or without dislocation at hospital admission