后交叉韧带损伤治疗医患须知

Posterior Cruciate Ligament Injuries

后交叉韧带损伤广东省中医院骨科许树柴

广州中医药大学附属广东省中医院二沙岛医院骨科 许树柴 翻译整理

The posterior cruciate ligament is located in the back of the knee. It is one of several ligaments that connect the femur (thighbone) to the tibia (shinbone). The posterior cruciate ligament keeps the tibia from moving backwards too far.

后交叉韧带位于膝盖的后面。它是众多连接股骨和胫骨韧带中其中一条。其功能为防止胫骨过度向后移动。

An injury to the posterior cruciate ligament requires a powerful force. A common cause of injury is a bent knee hitting a dashboard in a car accident or a football player falling on a knee that is bent.

致后交叉韧带损伤一般是受到暴力冲击。损伤的常见原因包括车祸时膝盖撞击到仪表盘，或者是足球运动员摔倒时膝盖着地。

Anatomy 解剖学

Two bones meet to form your knee joint: your thighbone (femur) and shinbone (tibia). Your kneecap sits in front of the joint to provide some protection.

股骨和胫骨共同结合形成膝关节。髌骨位于在膝关节的前方，可以保护膝关节。

Bones are connected to other bones by ligaments. There are four primary ligaments in your knee. They act like strong ropes to hold the bones together and keep your knee stable.

韧带能够维持骨头之间的联系。膝关节周围主要有四条韧带。这四条主要的韧带如同结实的绳索锁住你的骨头，以保持你的膝关节的稳定。

Collateral ligaments. These are found on the sides of your knee. The medial collateral ligament is on the inside and the lateral collateral ligament is on the outside. They control the sideways motion of your knee and brace it against unusual movement.

侧副韧带 侧副韧带位于膝关节的侧面。内侧副韧带位于膝关节的内侧边，外侧副韧带位于膝关节的外侧边。它们的主要功能为控制膝关节的横向移动，阻止其不寻常的移动。

Cruciate ligaments. These are found inside your knee joint. They cross each other to form an "X" with the anterior cruciate ligament in front and the posterior cruciate ligament in back. The cruciate ligaments control the back and forth motion of your knee.

交叉韧带 交叉韧带位于膝关节的里面。其中前交叉韧带位于前方，后交叉韧带位于后方，它们共同交叉形成一个“X”形。交叉韧带的主要功能为控制膝关节的前后移动。

The posterior cruciate ligament keeps the shinbone from moving backwards too far. It is stronger than the anterior cruciate ligament and is injured less often. The posterior cruciate ligament has two parts that blend into one structure that is about the size of a person's little finger.

后交叉韧带可以防止胫骨过度向后方移动。它比前交叉韧带更加坚韧，且不容易损伤。后交叉韧带由两部分组成，其尺寸大小大概与成人的小指大小一样。

小于14.5岁未成年人后交叉韧带损伤另有操作指南

Description 描述

Injuries to the posterior cruciate ligament are not as common as other knee ligament injuries. In fact, they are often subtle and more difficult to evaluate than other ligament injuries in the knee.

相对其他膝关节韧带来说，后交叉韧带的损伤没那么常见。事实上，后交叉韧带的损伤往往比较细微，相对膝关节其他韧带更加难以评估。

Many times a posterior cruciate ligament injury occurs along with injuries to other structures in the knee such as cartilage, other ligaments, and bone.

许多时候后交叉韧带的损伤常常伴有膝关节其他部位的损伤，包括软骨损伤，其他韧带的损伤，或者是骨头的损伤。

Injured ligaments are considered "sprains" and are graded on a severity scale.

韧带损伤往往与“扭伤”有关，根据其损伤严重程度可分为三个等级。

Grade 1 Sprains. The ligament is mildly damaged in a Grade 1 Sprain. It has been slightly stretched, but is still able to help keep the knee joint stable.

一级扭伤。 韧带轻微损伤，轻度的拉伸，但仍然能保持膝关节稳定。

Grade 2 Sprains. A Grade 2 Sprain stretches the ligament to the point where it becomes loose. This is often referred to as a partial tear of the ligament.

二级扭伤。 韧带损伤，中度的拉伸，使它变得松弛。此时通常被称为韧带部分撕裂。

Grade 3 Sprains. This type of sprain is most commonly referred to as a complete tear of the ligament. The ligament has been split into two pieces, and the knee joint is unstable.

三级扭伤。 韧带三级扭伤通常被称为韧带断裂。损伤的韧带断成两部分，此时膝关节十分不稳定。

Posterior cruciate ligament tears tend to be partial tears with the potential to heal on their own. People who have injured just their posterior cruciate ligaments are usually able to return to sports without knee stability problems.

后交叉韧带部分损伤后，有潜在的自我愈合能力。如果患者仅仅是后交叉韧带损伤，他们通常能够再次投入运动，并且膝关节不会出现不稳定。

Cause 原因

An injury to the posterior cruciate ligament can happen many ways. It typically requires a powerful force.

导致后交叉韧带的损伤原因有很多，通常情况下是遭到了暴力冲击。

· A direct blow to the front of the knee (such as a bent knee hitting a dashboard in a car crash, or a fall onto a bent knee in sports)

· 膝关节前方受到直接暴力（例如车祸时膝盖撞击到仪表盘，或者是运动时不慎摔倒致膝盖着地）

· Pulling or stretching the ligament (such as in a twisting or hyperextension injury)

· 韧带受到牵拉力或者是拉伸力（例如扭伤或者过度伸展）

· Simple misstep

· 失足

Symptoms 症状

The typical symptoms of a posterior cruciate ligament injury are:

后交叉韧带损伤典型的症状有：

· Pain with swelling that occurs steadily and quickly after the injury

· 损伤后迅速、持续出现疼痛、肿胀

· Swelling that makes the knee stiff and may cause a limp

· 膝关节僵硬，可能同时伴有跛行

· Difficulty walking

· 行走困难

· The knee feels unstable, like it may "give out"

· 膝关节不稳定，乏力

Doctor Examination 医生检查

During your first visit, your doctor will talk to you about your symptoms and medical history.

第一次看诊时，医生将会详细询问你的症状以及病史。

During the physical examination, your doctor will check all the structures of your injured knee, and compare them to your non-injured knee. Your injured knee may appear to sag backwards when bent. It might slide backwards too far, particularly when it is bent beyond a 90° angle. Other tests which may help your doctor confirm your diagnosis include X-rays and magnetic resonance imaging (MRI). It is possible, however, for these pictures to appear normal, especially if the injury occurred more than 3 months before the tests.

做体格检查时，医生将会检查患侧和健侧膝关节的所有部位，并做出对比。当患侧膝关节弯曲时，可能会出现胫骨向后方倾斜，特别是当弯曲的角度大于90°时，胫骨可能会向后方过度移动。除了体格检查之外，其它辅助检查包括X片和MRI可以帮助医生明确诊断。然而，如果后交叉韧带损伤的时间已经超过三个月，影像显现出来的图像也有可能提示是正常的。

X-rays. Although they will not show any injury to your posterior cruciate ligament, X-rays can show whether the ligament tore off a piece of bone when it was injured. This is called an avulsion fracture.

X片。尽管X片显示不了后交叉韧带的损伤，但是能够提示是否由韧带撕脱所引起的骨折，通常我们会把这种类型的骨折称之为撕脱骨折。

MRI. This study creates better images of soft tissues like the posterior cruciate ligament.

MRI。MRI能够更清楚地显示出软组织，其中包括后交叉韧带。

Treatment 治疗

Nonsurgical Treatment 非手术治疗

If you have injured just your posterior cruciate ligament, your injury may heal quite well without surgery Your doctor may recommend simple, nonsurgical options.

如果你仅仅是后交叉韧带损伤，即使没有采取手术治疗，它也可以愈合得很好。所以医生可能会建议采取简单，非手术的治疗方法。

RICE. When you are first injured, the RICE method - rest, ice, gentle compression and elevation — can help speed your recovery.

RICE治疗。当你第一次损伤时，采用RICE治疗方法可以更加快速地帮助你恢复。RICE治疗方法由四个步骤组成，分别是休息，冰敷，轻微地加压以及抬高下肢。

Immobilization. Your doctor may recommend a brace to prevent your knee from moving. To further protect your knee, you may be given crutches to keep you from putting weight on your leg.

制动。医生会对患侧膝关节进行制动以防止它随意移动。为了更妥善地保护患侧膝关节，医生会建议患者使用拐杖，以减轻其负重。

Physical therapy. As the swelling goes down, a careful rehabilitation program is started. Specific exercises will restore function to your knee and strengthen the leg muscles that support it. Strengthening the muscles in the front of your thigh (quadriceps) has been shown to be a key factor in a successful recovery.

物理治疗。当肿胀消退时，可以开始进行康复锻炼。定期的锻炼将会恢复患侧膝关节的功能以及加强其肌肉的力量。加强股骨前方肌群的肌力已经被认为是成功康复的一个重要因素。

Surgical Treatment 手术治疗

Your doctor may recommend surgery if you have combined injuries. For example, if you have dislocated your knee and torn multiple ligaments including the posterior cruciate ligament, surgery is almost always necessary.

如果你存在多部位的损伤，医生可能会建议你进行手术治疗。举个例子，假如你的膝关节脱位了，同时伴有后交叉韧带在内的多条韧带损伤，此时必须进行手术治疗。

Rebuilding the ligament. Because sewing the ligament ends back together does not usually heal, a torn posterior cruciate ligament must be rebuilt. Your doctor will replace your torn ligament with a tissue graft. This graft is taken from another part of your body, or from another human donor (cadaver). It can take several months for the graft to heal into your bone.

重建韧带。后交叉韧带断裂必须进行重建。这是因为韧带断裂末端即使缝合在一起，通常很难愈合。此时医生将会移植一段组织来代替断裂的韧带。这些组织可以来源于患者身体上的其他部位，也可以来源于他人的捐赠。但要使这些移植的组织成功长到骨头上大概需要几个月的时间。

Procedure. Surgery to rebuild a posterior cruciate ligament is done with an arthroscope using small incisions. Arthroscopic surgery is less invasive. The benefits of less invasive techniques include less pain from surgery, less time spent in the hospital, and quicker recovery times.

手术步骤。操作关节镜进行后交叉韧带重建术，只需一个小切口，具有创伤小的特点。这种微创技术的优势在于不仅可以减少患者痛苦，同时可以减少手术时间以及使患者快速康复。

Surgical procedures to repair posterior cruciate ligaments continue to improve. More advanced techniques help patients resume a wider range of activities after rehabilitation.

目前后交叉韧带修复手术在不断地进行改良之后，涌现出越来越多的先进技术，帮助患者康复后可以进行更多的运动。

Rehabilitation 康复

Whether your treatment involves surgery or not, rehabilitation plays a vital role in getting you back to your daily activities. A physical therapy program will help you regain knee strength and motion. If you had surgery, physical therapy will begin 1 to 4 weeks after your procedure.

无论你是否选择手术治疗，康复锻炼都扮演着十分重要的角色。它能够让你重新回到日常生活中。而进行物理治疗将会帮助你恢复膝关节的力量和活动。如果你选择手术治疗，物理治疗将会在手术后1到4周内进行。

How long it takes you to recover from a posterior cruciate ligament injury will depend on the severity of your injury. Combined injuries often have a slow recovery, but most patients do well over time.

后交叉韧带损伤的康复时间决定于其损伤的严重程度。通常情况下多部位的损伤康复时间较为漫长，但大多数患者的恢复情况都很好。

If your injury requires surgery, it may be several weeks before you return to a desk job - perhaps months if your job requires a lot of activity. Full recovery typically requires 6 to 12 months.

如果你的伤势急需手术治疗，那可能需要休息几个星期后才能回到办公室工作。如果是属于高强度工作，则可能需要休息几个月。一般来说，整个康复过程需要六到十二个月。

Although it is a slow process, your commitment to therapy is the most important factor in returning to all the activities you enjoy.

尽管这个过程很漫长，然而为了回归一切你喜欢的活动，最重要的因素是你需要配合治疗。