中国组织工程研究

中国组织工程研究 ›› 2022, Vol. 26 ›› Issue (26): 4205-4210.doi: 10.12307/2022.825

• 组织构建临床实践 clinical practice in tissue construction • 上一篇    下一篇

关节镜下修复重建膝关节脱位多发韧带损伤后的三维步态分析

何  璐1，廖欣宇1，李彦林1，阮艳琴2，王  旭1，王  扬1，宁梓文1，施政良1，王国梁1   

  1. 1昆明医科大学第一附属医院运动医学科，云南省昆明市  650032；2昆明医科大学公共卫生学院，云南省昆明市  650500
  • 收稿日期:2021-05-28 接受日期:2021-07-16 出版日期:2022-09-18 发布日期:2022-03-09
  • 通讯作者: 王国梁，在读博士，主治医师，昆明医科大学第一附属医院，云南省昆明市 650032
  • 作者简介:何璐，男，1993年生，河南省周口市人，汉族，昆明医科大学在读硕士，主要从事骨与骨关节损伤的修复与重建研究。
  • 基金资助:
    云南省科技厅昆明医科大学应用基础研究专项资金面上项目(202001AY070001-043)，项目负责人：王国梁；云南省陈世益专家工作站(2018IC102)，项目负责人：李彦林；云南省骨关节疾病临床医学中心项目(zx2019-03-04)，项目负责人：李彦林

Arthroscopic repair of multiple ligament injuries after knee joint dislocation: a three-dimensional gait analysis

He Lu1, Liao Xinyu1, Li Yanlin1, Ruan Yanqin2, Wang Xu1, Wang Yang1, Ning Ziwen1, Shi Zhengliang1, Wang Guoliang1   

  1. 1Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China; 2School of Public Health, Kunming Medical University, Kunming 650500, Yunnan Province, China
  • Received:2021-05-28 Accepted:2021-07-16 Online:2022-09-18 Published:2022-03-09
  • Contact: Wang Guoliang, MD candidate, Attending physician, Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China
  • About author:He Lu, Master candidate, Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China
  • Supported by:
    the General Program of the Special Fund for Applied Basic Research of Kunming Medical University & Yunnan Provincial Department of Science and Technology, No. 202001AY070001-043 (to WGL); Chen Shiyi Expert Workstation Project in Yunnan Province, No. 2018IC102 (to LYL); Yunnan Provincial Bone and Joint Disease Clinical Medicine Center Project, No. zx2019-03-04 (to LYL)

PDF

49

摘要：

文题释义：
膝关节多发韧带损伤：是在高能量创伤下，导致膝关节前、后交叉韧带和侧副韧带中2个或2个以上断裂的严重损伤。一般来说，大多数膝关节脱位多发韧带损伤会造成膝关节脱位，根据Schenck分型可以分为5型。膝关节脱位通常是涉及膝关节韧带、血管、皮肤、神经、骨折、头部损伤和其他器官系统创伤的多系统损伤的一部分，这些系统损伤将影响膝关节脱位治疗的结果。因此，膝关节脱位多平面不稳定和多韧带损伤的正确诊断和治疗是取得手术成功的关键。
三维步态分析：是通过红外运动捕捉技术与数字导航技术对膝关节的内外旋、上下位移、前后位移、内外位移等6个自由度的运动指标进行对比分析。通过监测步态频率和步长提供客观的结果度量，客观分析膝关节脱位多发韧带损伤患者的步态特征，有助于指导患者术后康复锻炼以提高生活质量。

背景：膝关节多发韧带损伤是一个复杂的问题，易伴发血管及神经损伤，导致严重的功能障碍。但目前对于膝关节脱位多韧带损伤的手术治疗上，手术时机的选择和术后步态指标缺乏评估。
目的：通过三维步态分析探讨Ⅰ期关节镜下修复重建膝关节脱位多发韧带损伤患者的临床治疗效果，为临床上指导膝关节多发韧带损伤术后功能锻炼提供参考依据。 
方法：2014年9月至2018年8月昆明医科大学第一附属医院收集15例膝关节脱位多发韧带损伤患者的临床资料，均为单膝损伤，男11例，女4例；年龄为18-40岁，平均(28±8)岁；受伤至手术时间为10-18 d，平均14 d。入院查体患者前、后抽屉试验阳性，Lachman试验阳性，8例患者膝内翻应力试验Ⅲ度阳性，5例患者膝外翻应力试验Ⅲ度阳性，Lysholm 膝关节功能评分(27.85±5.98)分、关节活动范围(49.15±13.47)°。于关节镜下Ⅰ期取自体腘绳肌腱修复重建前交叉韧带、后交叉韧带、内侧副韧带以及其他有所损伤的膝关节结构，术后评估膝关节活动范围、Lysholm评分并进行术后三维步态分析。
结果与结论：①15例患者术后伤口均Ⅰ/甲级愈合，获11-24个月随访，所有患者术后随访前、后抽屉试验及膝内、外翻应力试验均为阴性；②修复后末次随访患肢Lysholm膝关节功能评分、关节活动范围显著提高，并且达到了损伤前活动水平，膝关节Lysholm评分为(85.3±6.65)分，膝关节活动度为(122.83±9.27)°，与术前比较差异均有显著性意义(t=24.879，P=0.000；t=17.452，P=0.000)；③运动学分析结果显示，与健康肢体相比，末次随访步态分析中内外翻角、内外位移、内外旋转、屈伸角、上下位移、前后位移无明显差异(P > 0.05)；④证实Ⅰ期关节镜修复膝关节多发韧带损伤可恢复膝关节的稳定性，是一种安全可靠、行之有效的治疗方法。
缩略语：膝关节脱位多发韧带损伤：knee dislocation with multiple ligament injuries，KDMLI

https://orcid.org/0000-0001-6207-1996 (何璐) 

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

关键词: 膝关节脱位多发韧带损伤, 关节镜, 修复重建, 三维步态分析, Lysholm评分

Abstract: BACKGROUND: Multiple ligament injuries of the knee are a complicated problem, which is prone to vascular and nerve damage, leading to severe dysfunction. However, for the current surgical treatment of knee dislocation and multiple ligament injuries, there is a lack of effective evaluation on the timing of surgery and postoperative gait. 
OBJECTIVE: To investigate the clinical effect of stage I arthroscopic repair and reconstruction in patients with multiple ligament injuries of the knee joint, and provide a reference for clinical guidance of functional exercises after multiple ligament injuries of the knee joint through a three-dimensional gait analysis. 
METHODS: The clinical data of 15 patients with multiple ligament injury of knee dislocation who were treated in the First Affiliated Hospital of Kunming Medical University from September 2014 to August 2018 were collected. All the cases were single knee injury, including 11 males and 4 females. Their age ranged from 18 to 40 years old, with an average of (28±8) years old. The time from injury to operation was 10-18 days, with an average of 14 days. At admission, the anterior and posterior drawer tests and the Lachman test were positive in all the patients. The knee varus stress test was positive in eight patients, and the knee valgus stress test was positive in five patients. Lysholm knee joint function score was (27.85±5.98) points, and joint range of motion was (49.15±13.47)°. Under arthroscopy, autologous hamstring tendons were taken to reconstruct the anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, and other injured knee joint structures. The range of knee joint motion and Lysholm score were evaluated, and three-dimensional gait analysis was conducted postoperatively.
RESULTS AND CONCLUSION: Grade I/A healing was found in 15 patients. All patients were followed up for 11-24 months. During the postoperative follow-up, all patients had negative results in the anterior and posterior drawer tests and in the knee varus and valgus stress tests. Lysholm knee function score and joint range of motion of the affected limb were significantly improved at the last follow-up after repair, which were (85.3±6.65) points and (122.83±9.27)°, respectively, significantly different from the preoperative levels (t=24.879, P=0.000; t=17.452, P=0.000). Results of kinematic analysis showed that there were no significant differences in varus and valgus angles, internal and external displacements, internal and external rotations, flexion and extension angles, up and down displacements, and anteroposterior displacements between the healthy and affected limbs in the gait analysis at the last follow-up (P > 0.05). All these findings indicate that stage I arthroscopic repair of multiple ligament injuries of the knee joint can restore the stability of the knee joint, which is a safe, reliable, and effective treatment.

Key words: knee dislocation with multiple ligament injuries, arthroscopy, repair and reconstruction, three-dimensional gait analysis, Lysholm score

中图分类号: