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相關文獻
- Injuries to the Posterior Cruciate Ligament and Posterolateral Instabilities of the Knee
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頁籤選單縮合
題名 | Injuries to the Posterior Cruciate Ligament and Posterolateral Instabilities of the Knee=膝關節後十字韌帶及後外側韌帶不穩定性 |
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作 者 | 王清貞; | 書刊名 | 長庚醫學 |
卷期 | 25:5 2002.05[民91.05] |
頁次 | 頁288-297 |
分類號 | 416.61 |
關鍵詞 | 後十字韌帶; 後側韌帶不穩定性; 膝關節; Posterior cruciate ligament; Posterolateral instability; Knee; |
語文 | 英文(English) |
中文摘要 | 與前十字韌帶受傷不同,因後十字韌帶受傷而產生的殘障程度,小到不影響生活品質,大到嚴重影響每日活動,所以後十字韌帶受傷的治療頗有爭議。包括車禍等高能量的外傷往往導致嚴重三度的後十字韌帶受傷,其他包括運動外傷等低能量外傷的後十字韌帶受傷程度比較不嚴重。後十字韌帶受傷後的癒合與韌帶不穩定的狀態及程度以及關節退化等有關係,治療方法也因韌帶受傷的輕重而異,受傷後經保守療法無效,膝關節有持續疼痛與不穩定性的情況之下,就要做開刀手術治療。 利用關節鏡做後十字韌帶重建可改善膝關節的功能與穩定性高達77.4%理想結果。韌帶穩定性完全矯正的有52%,大約1/3的膝關節仍有輕度的韌帶鬆弛,這種問題在中程時間追?時,不影響膝關節的功能。因後十字韌帶受傷而引發的退化性關節炎比例是52%,這與受傷時間,受傷的嚴重程度有直接關係。所以,後十字韌帶受傷的意義往昔有被簡單化的趨勢,它的嚴重度也被低估,第三度嚴重性的後十字韌帶受傷,早期開刀治療,癒後及後果都比較理想。 後十字韌帶常常和其他韌帶一起受傷,後十字韌帶和後外側韌帶受傷是很嚴重的膝關節外傷,往往導致機能殘障,膝關節疼痛及不穩定性及退化性關節炎。這種外傷大部份要接受開刀治療,目前的開刀方式包括利用骼脛束(Ilotibial band)來重建膕肌腱(popliteus tendon),利用股二頭肌(biceps femoris)來重造外側韌帶(lateral collateral ligament),或兩者合併做。中短期追?的開刀結果是64%滿意,36%不滿意,僅有44%的膝關節完全恢復韌帶穩定性,受傷後的退化性關節炎比率是44%,這與受傷的時間與嚴重程度有關係。目前的開刀治療方法雖然對韌帶穩定性的痊癒還不盡完善,但是病人對開刀的滿意度高達87%,對因後十字韌帶與後外側韌帶不穩定性的膝關節的治療,目前是一項尚未解決的骨科問題。 |
英文摘要 | Unlike anterior cruciate ligament (ACL) injury, disability from isolated posterior cruciate ligament (PCL) injury varies from no interference with life style to severe impairment of daily activities. Therefore, management of isolated PCL injuries remains controversial. High-energy vehicular accidents often cause more-serious PCL injuries, while less-severe injuries result from low-energy trauma including sports. The natural history and prognosis of PCL injury are correlated with the type and extent of instability and the development of degenerative changes in the knee. Indications for surgery include pain and instability of the knee. Arthroscopic single-bundle PCL reconstruction improved the function and stability of the knee with 77.4% satisfactory results in medium-term follow-up. Complete restoration of ligament stability was achieved in only 52% of knees, while 1/3 of the knees showed mild and 9.7% showed moderate residual ligament laxity. The incidence of degenerative changes was 52%, and the rate was correlated with duration of injury and severity of ligament laxity. Therefore, the significance of PCL injury has been overly simplified, and the functional disability of knees with PCL injury underestimated. Early surgical reconstruction of knees with grade [] PCL injury is recommended. PCL injury is frequently associated with multiple ligamentous injuries. Combined PCL and posterolateral instabilities are serious knee injuries and frequently result in severe functional disability due to pain, instability, and degenerative changes in the knee. Unlike isolated PCL injury, there is a consensus of opinion that surgical reconstruction is indicated in knees with combined PCL and posterolateral instabilities. Commonly employed methods of reconstruction of the posterolateral corner include popliteus reconstruction, lateral collateral reconstruction or advancement, and a combination of the two. Combined arthroscopic PCL reconstruction and posterolateral reconstruction achieved 64% satisfactory (24% excellent and 40% good) and 36% unsatisfactory (24% fair and 12% poor) results over an average of 32 months of follow-up. Complete restoration of ligament stability was noted in only 44% of knees. The incidence of degenerative changes was 44%, and the rate was correlated with duration from injury to surgery and severity of ligament laxity. Despite the fact that currently employed surgical techniques only achieve modest success in restoration of ligament stability, early surgical reconstruction in knees with combined PCL and posterolateral instabilities achieved the best clinical results and a high rate of patient satisfaction. |
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