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- Early Reconstruction of Acute Anterior Cruciate Ligament Rupture with Central One-Third Bone Patellar Tendon Bone Graft
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頁籤選單縮合
題名 | Early Reconstruction of Acute Anterior Cruciate Ligament Rupture with Central One-Third Bone Patellar Tendon Bone Graft=急性膝關節前十字韌帶完全斷裂的重建 |
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作 者 | 林柳池; 邵克勇; | 書刊名 | 中華民國外科醫學會雜誌 |
卷期 | 29:3 民85.05-06 |
頁次 | 頁229-239 |
分類號 | 416.61 |
關鍵詞 | 急性膝關節; 十字韌帶; 斷裂; ACL; Acute rupture; Reconstruction; |
語文 | 英文(English) |
中文摘要 | 四十八例急性膝關節前十字韌帶完全斷裂的病例,施以中三分之一檳骨 韌帶重建術,經過二至五年的追蹤提出報告。術前所有病人呈現陽性 Lach-mantest。於麻醉下理學檢查82病患呈現Later-alpivotshift症候,內側附韌帶同 時損傷有十二例。所有病人皆經關節鏡檢查確立診斷。半月板破裂佔25。重建術 皆用自體檳骨韌帶,移植物以鋼鑲絲固定。手術方法採用Mini-arthrotomy及 Rearentrytechnique。手術後膝關節固定於零度有30例,仲有內側附韌帶修補者固 定於30度計12例。術後採取漸進性保護性的膝關節復健運動。追蹤評估發現 Lysholm score平均85點。82病例Lachman test少於第一度,91無pivot shift症候。K-T 1000檢查88病人少於3mm。肌力測試與正常側比較少18。膝關節無法伸直,角度 大於10°者有三例。無法完全彎曲角度小於125°者有4例。對於急性膝關節前十 字韌帶完全斷裂,施以自體臏骨韌帶重建,術後可以得到滿意的穩定度,惟關節 活動幅度的部份喪失雖然給予積極的復健工作,仍然不可避免。 |
英文摘要 | A prospective review was undertaken at this institution after using a procedure involving use of the central one-third of the patellar ligament as afree, autogenous graft for early reconstruction of a ruptured acute anteriorcruciate ligament (ACL) for 48 patients. The patients, 42 males and 6 females with a mean age of 21 years (range, 19 to 32), were followed for 2 to 5years (mean, 30 months). Patients were evaluated by physical examination,with a K-T 1000 arthrometer, radiographs and the Cybex II+ dynamometer, as well as by obtaining a Lysholm score for rating the ligament. Preoperatively, there were 42 patients with joint swelling. Range of motion inflexion was less than 120° in 34 cases. Less than 10° of extension was notedin 23 cases. Under anesthesia, stability examination showed 100 of the patients positive in the Lachman test, 82 positive in the lateral pivot shifttest. Associated injury of the medial collateral ligament was noted in 12cases and, in 25 cases, there was meniscal tear. The surgical procedure wasapproached by two incisions through a mini-arthrotomy of the graft defectand the rear entry technique. After operation, the knee was put in fullextension in 30 cases and 30° of flexion in 18 cases. Postoperative care to include early and limited protective motion was encouraged. Postoperatively,the average scale of Lysholm scores was 85 points. Clinical examination demonstrated that 82 had less than 1+ Lachman test; 91 had a negativepivot shift. KT-1000 arthrometer revealed that 88 of the cases had lessthan 3 mm difference. Mean quadriceps muscle strength loss was on anaverage of 18. Loss of extension greater than 10° was noted in three casesand flexion less than 125@ in four. Although early reconstruction of acuteACL tear is reliable to achieve knee stability, no matter how aggressive therehabilitation attempts, the risk of loss of motion reaches high percentage.To prevent loss of motion, delaying acute reconstruction until the acuteinflammatory phase of the injured knee has ended may be the best option. |
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