标题：关节镜下一期LARS人工韧带重建术在多发膝关节韧带损伤修补中的应用

      作者：高腾飞 1，夏斌 2，陈其亮 3，赵涛 3，方海林 3    1.陕西省结核病防治院(陕西省第五人民医院)骨科，陕西 西安 710100；2.宝鸡市中医医院骨二科，陕西 宝鸡 721001；3.陕西省结核病防治院(陕西省第五人民医院)外科，陕西 西安 710100

      卷次： 2019年30卷24期

      【摘要】 目的 探究关节镜下一期韧带高级加固系统(LARS)人工韧带重建术在多发膝关节韧带损伤修补中的应用效果，为临床诊疗提供参考依据。方法 选择2017年6月至2018年6月在陕西省第五人民医院治疗的多发膝关节韧带损伤患者32例为研究对象。经CT、MRI检测发现22例患者出现前交叉韧带(ACL)、后交叉韧带(PCL)与内侧副韧带(MCL)损伤，10例有ACL、PCL与后外侧角(PLC)损伤。对所有患者实施关节镜下一期LARS人工韧带重建术，实施麻醉后进行交叉韧带、侧副韧带手术。并于1年后随访时，选择前后抽屉、Lachman测试、Lysholm评分以及膝关节活动度对膝关节功能进行评估。结果 32例患者手术均顺利结束，未出现并发症，且全部患者术后诊断与术前相同；手术前3例伴发腓总神经损伤患者经营养神经治疗后均得到不同程度的恢复；所有患者均获得随访，随访时间6~14个月，平均(11.52±1.26)个月；患者骨折、撕裂的半月板等均愈合，深静脉血栓成功溶解；最后一次随访时对所有患者进行膝内外翻应力测试，结果显示基本正常或正常，通过前后抽屉、Lachman测试显示均为阴性，移位距离关于胫骨前后的均小于5 mm，且患者没有出现自觉性症状，通过MRI、CT显示胫骨股骨隧道、腱骨成功愈合、内固定物的位置不发生变化、重建的韧带走行与重塑好；3例伴发腓总神经损伤患者手术1年后基本恢复感觉运动；所有患者术后 1年Lysholm评分为(92.43±1.84)分，明显高于术前的(40.52±3.17)分，差异有统计学意义(P<0.05)；所有患者主动膝关节活动度平均为(122.64±8.34)°，明显高于术前的(87.24±5.97)°，差异有统计学意义(P<0.05)。结论 关节镜下一期LARS人工韧带重建术治疗多发膝关节韧带损伤患者疗效显著，值得推广应用。
      【关键词】 多发韧带损伤；韧带高级加固系统；膝关节；人工韧带重建术；关节镜；膝关节功能
      【中图分类号】 R687.4 【文献标识码】 A 【文章编号】 1003—6350（2019）24—3178—03

Application of arthroscopic reconstruction of LARS artificial ligament in multiple knee joint ligament injuryrepair.
GAO Teng-fei 1, XIA Bin 2, CHEN Qi-liang 3, ZHAO Tao 3, FANG Hai-lin 3. 1. Department of Orthopedics, ShaanxiProvincial Tuberculosis Prevention and Control Hospital, Shaanxi Fifth People's Hospital, Xi'an 710100, Shaanxi, CHINA;2. Second Department of Orthopedics, Baoji Chinese Traditional Medicine Hospital, Baoji 721001, Shaanxi, CHINA; 3.Department of General Surgery, Shaanxi Provincial Tuberculosis Prevention and Control Hospital, Shaanxi Fifth People'sHospital, Xi'an 710100 , Shaanxi, CHINA
【Abstract】 Objective To explore the application of the first Ligament Advanced Reinforcement System(LARS) artificial ligament reconstruction in the repair of multiple knee ligament injury, and to provide reference for clini-cal diagnosis and treatment. Methods A total of 32 patients with multiple knee ligament injuries, who were treated inShaanxi Provincial Fifth People's Hospital from June 2017 to June 2018, were selected as the study objects. CT and MRIshowed that 22 patients had ACL, PCL and MCL injuries, and 10 patients had ACL, PCL and PLC injuries. All patientsunderwent arthroscopic reconstruction of the LARS artificial ligament, anesthesia for cruciate ligament and lateral collat-eral ligament surgery. At one year of follow-up, knee function was evaluated by front and rear drawers, Lachman test,Lysholm score, and knee mobility. Results All 32 patients underwent surgery successfully, no complications occurred,and all patients were diagnosed after surgery as before surgery; three patients with peroneal nerve injury before surgeryreceived different degrees of recovery after nutritional neurotherapy; all patients were followed up for 6-14 months, withan average of (11.52±1.26) months; the fractured and torn meniscus was healed and the deep vein thrombosis were suc-cessfully dissolved; at the last follow-up, the knee internal and external valgus stress test were performed on the patient,the results showed that it was basically normal or normal; it was negative by front and rear drawers and Lachman test,the displacement distance was less than 5 mm before and after the humerus, and the patient did not have symptoms; theresults of MRI and CT showed that the tibiofemoral tunnel and the humerus were successfully healed, the position of theinternal fixation was not changed, and the reconstructed ligament was rehabilitated and remodeled, and three patientswith common peroneal nerve injury recovered the sensorimotor after one year of surgery. One year after operation, theLysholm score in all patients was 92.43±1.84, which was significantly higher than 40.52±3.17 before surgery (P<0.05);the average active knee joint activity was (122.64±8.34)° versus (87.24±5.97)° (P<0.05). Conclusion The application