膝关节内侧副韧带、前交叉韧带、后交叉韧带联合损伤的手术治疗

目的探讨关节镜下膝关节前交叉韧带(ACL)、后交叉韧带(PCL)、内侧副韧带联合损伤(Ⅲ度膝关节外翻伤)的手术治疗方法。方法关节镜下同时联合重建ACL、PCL并修复内侧副韧带和内侧关节囊，8例交叉韧带重建材料来源于自体双侧髌腱中1／3骨-腱-骨结构，8例采用同种异体髌腱重建，交叉韧带重建的同时进行膝关节内侧副韧带和关节囊的修补。术后佩戴可调式卡盘支具3个月，并给予严格的康复训练。结果术后随访6～18个月，所有患者主观感觉以及膝关节稳定程度恢复良好，均进行正常生活与工作，同种异体髌腱移植重建比自体髌腱移植重建前后交叉韧带手术时间短，效果更好，没有发现明显的排异反应和感染传染性疾病的现象。结论1期行关节镜手术治疗膝关节内侧副韧带、前交叉韧带／后交叉韧带联合损伤，使用安全，效果满意；同种异体髌腱是重建物是一个可以选择的来源，效果优于自体髌腱移植重建。

Arthroscopic reconstruction by using allograft and autograft to treat combined anterior/posterior cruciate ligament and medial side injuries of the knee

Objective To explore the treatment method for combined anterior cruciate ligament (ACL) , posterior cruciate ligament ( PCL) and medial side injuries of the knee under arthroscope. Methods Eight cases wigh combined ACL, PCL and medial side injuries of the knee were reconstructed with autograft of patellar bone-tendon-bone and eight with allograft of patellar bone-tendon-bone. Results All patients were followed up for 6-18 months (average 12 months). All patients were with relief of symptoms, restoration of knee stability and minor immunologic rejection. Reconstruction with allograftt was characterized by shorter operation time and better outcome compared with that with autograft. No infections of HIV/HBV/HCV or inflammation were seen. Conclusions The clinical outcome of the allograft is superior to that of autograft in reconstruction of combined ACL, PCL and medial side injuries of the knee at one stage. Allograft is a reasonable alternative for multiple ligament surgery.