关节镜下解剖等长重建技术在LARS韧带重建前交叉韧带中的应用

目的 探讨前交叉韧带(ACL)解剖等长重建技术在关节镜下LARS韧带重建前交叉韧带术中应用的可行性及近期疗效.方法 用LARS人工韧带对8例前交叉韧带损伤行关节镜下ACL重建术.采用前交叉韧带解剖等长重建技术钻胫骨、股骨骨道,将LARS韧带拉入骨道,韧带游离部分位于关节腔内,拉紧后2枚界面螺钉固定韧带.结果 手术时间30～80 min,平均56 min.术后无滑膜炎、韧带断裂、活动明显受限等并发症.8例均随访2～6个月,平均4个月.根据Lysholm膝关节功能评分,术前评分为22～65分(40.25±17.07)分;术后评分为80～93分(88.75±4.06)分(t=8.083,P＜0.01).结论 前交叉韧带解剖等长重建技术在关节镜下LARS韧带重建前交叉韧带术中操作简便,效果可靠,值得推广.     

关节镜下解剖等长重建技术在重建前交叉韧带中的应用

[目的]探讨前交叉韧带(ACL)解剖等长重建技术在关节镜下应用的可行性及近期疗效.[方法]对20例前交叉韧带损伤行关节镜下ACL重建木.采用前交叉韧带解剖等长重建技术钻胫骨、股骨骨道.移植物用LARS人工韧带11例,用四股半腱肌股薄肌腱9例.LARS人工韧带用2枚界面螺钉固定韧带,四股半腱肌股薄肌腱股骨端用Endobutton固定、胫骨端用可吸收界面螺钉固定.[结果]手术时间LARS人工韧带组30～80 min,平均56 min.四股半腱肌股薄肌腱组80～120 min,平均100 min.20例均随访6～12个月,平均9个月.根据Lysholm膝关节功能评分,LARS人工韧带组术前评分22～65分(36.72±15.54)分;术后6个月评分80～98分(90.45±4.68)分(t=10.535,P＜0.01).四股半腱肌股薄肌腱组术前评分20～60分(37.11±12.26)分;术后6个月评分75～87分(80.44±4.16)分(t=9.615,P＜0.01).术后6个月LARS人工韧带组与四股半腱肌股薄肌腱组评分在统计学上有显著差异(t=10.569,P＜0.01).[结论]前交叉韧带解剖等长重建技术在关节镜下重建前交叉韧带术中操作简便,效果可靠,值得推广.LARS人工韧带组近期疗效明显优于四股半腱肌股薄肌腱组.     

关节镜下LARS人工韧带重建后交叉韧带

目的探讨关节镜下LARS人工韧带重建后交叉韧带（PCL）可行性及近期疗效。方法用LARS人工韧带对6例PCL损伤患者行关节镜下PCL重建术。采用PCL重建技术钻胫骨、股骨骨道,将LARS韧带拉入骨道,韧带游离部分位于关节腔内,拉紧后2枚界面螺钉固定韧带。结果手术时间50-80（65±9.92）min。术后无滑膜炎、韧带断裂、活动明显受限等并发症。6例随访6-12（8±2.28）个月。根据Lysholm膝关节功能评分,术前评分：20-37（23.67±10.84）分;术后评分：84-93（88.00±3.46）分（t=16.69,P〈0.01）。结论关节镜下LARS人工韧带重建PCL术中操作简便,效果可靠。     

LARS韧带在超常体重人群前交叉韧带重建中的应用

目的 观察LARS人工韧带在超常体重人群前交叉韧带(ACL)重建的近期疗效.方法 LARS人工韧带行ACL重建11例,均在关节镜下完成.结果 本组随访13～18个月,术前前抽屉试验(+++),轴移试验阳性,Lysholm评分(58.08±7.44)分.术后前抽屉试验、轴移试验(一),Lysholm评分(89.47±8.70)分.结论 LARS人工韧带具有良好的生物力学性能,用于超常体重人群重建ACL近期疗效满意,提示LARS在治疗该类患者ACL损伤中可能具有一定的优势.     

关节镜下LARS人工韧带及4股半腱肌肌腱重建前交叉韧带

目的评价LARS人工韧带和自体4股半腱肌肌腱关节镜下重建膝前交叉韧带（ACL）的临床疗效。方法对28例膝ACL断裂患者行关节镜下ACL重建术,根据重建材料的来源分为LARS人工韧带组（13例）和自体4股半腱肌肌腱组（15例）。采用ACL解剖等长重建技术建立胫骨、股骨骨道。并对两组的关节稳定性和Lysholm膝关节功能评分进行对比研究。结果术后膝关节稳定性LARS人工韧带组优于4股半腱肌肌腱组（P〈0.05）。移植后两组Lyshrolm膝关节功能评分较移植前提高（P〈0.05）。术后6个月LARS人工韧带组Lysholm评分（90.4分±5.3分）高于4股半腱肌肌腱组（81.2分±4.7分）（P〈0.05）。结论在关节镜下重建ACL术中,LARS人工韧带可作为自体材料的良好替代物。     

LARS人工韧带关节镜下重建膝前交叉韧带

目的 探讨关节镜下LARS人工韧带治疗膝关节前交叉韧带（ACL）完全性损伤的疗效。方法对12例ACL完全损伤患者实施关节镜下LARS人工韧带重建术。结果12例均获随访,时间3～11个月,膝关节前直向不稳症状均消失,前抽屉试验阴性,关节功能良好,未并发急性滑膜炎。患膝伸屈度0°～120°。根据Lysholm膝关节评分法,膝关节评分由术前（45．45±1．18）分提高到术后（84．77±2．26）分。结论LARS人工韧带组织相容性好,是理想的韧带移植材料。关节镜下LARS人工韧带重建ACL完全性损伤疗效好,创伤小,并发症少,患膝稳定性早期即可完全恢复,术后关节功能能达到正常运动要求。     

关节镜下LARS人工韧带重建后交叉韧带

目的 探讨在关节镜下应用韧带增强重建系统(ligament advanced reinforcement system,LARS)人工韧带重建膝关节后交叉韧带的手术方法和临床疗效. 方法 2006年6月-2007年7月,应用LARS人工韧带在关节镜下重建9例膝关节后交叉韧带断裂患者.男8例,女1例;年龄23～49岁.左膝3例,右膝6例.致伤原因:运动扭伤5例,摔伤1例,车祸伤3例.伤后至手术时间6～20 d,平均13.6 d.合并内侧半月板损伤2例,外侧半月板损伤1例.X线片示胫骨平台无撕脱骨折.术前Lysholm膝关节功能评分为40～55分,平均50分:按国际膝关节评分委员会(international kneedocumentation commime,IKDC)评分C级1例,D级8例:反Lachman试验( )l例,( )6例,( )2例.治疗在关节镜下完成,后交叉韧带胫骨止点、隧道用"定位器"完成;股骨止点、隧道在C臂X线机下完成;骨隧道直径为6 mm,LARS人工韧带直径为7 mm. 结果 本组术后切口均1期愈合,无手术相关并发症发生.所有患者均获随访,随访时间8～16个月,平均10.5个月.术后Lysholm评分70～95分,平均85分;优5例,良3例,可1例,优良率为88%.术后IKDC评分A级7例,B级2例;反Lachman试验均为阴性.无术后感染、韧带自发断裂、松动等并发症发生. 结论 运用LARS人工韧带重建膝后交叉韧带可达到解剖重建,有效恢复膝关节稳定性;且关节镜下手术创伤小、康复快、疗效好.     

自体四股胭绳肌腱与LARS人工韧带重建前交叉韧带临床疗效比较

目的 对照研究自体四股胭绳肌腱(4SHG)与LARS人工韧带重建前交叉韧带(ACL)手术的早期临床疗效.方法 对52例ACL损伤分别应用4SHG或LARS人工韧带作为移植物进行关节镜下重建.均在术前及术后3、6、12和24个月进行Lysholm、Tegner、IKDC评分.结果 术后24个月LARS人工韧带组和自体4SHG组3种膝关节功能评分都较术前明显改善,差异有统计学意义(P＜0.01).术后12个月LARS人工韧带组ACL重建的3种膝关节功能评分值均显著高于4SHG组(P＜0.01);至术后24个月时数值差异无统计学意义(P＞0.05).结论 关节镜下应用LARS人工韧带和4SHG重建ACL术后24个月随访临床效果满意,LARS人工韧带在术后早期的功能改善方面有着显著的优势,膝关节功能恢复更快.     

关节镜下LARS重建后交叉韧带的近期疗效

目的探讨在关节镜下应用LARS重建后交叉韧带（PCL）的近期疗效。方法7例陈旧性PCL损伤患者在伤后2～13个月使用LARS人工韧带（PPLY110）作双束双隧道PCL重建。结果7例均获随访,时间5～25个月,膝关节稳定性良好,膝活动度较术前改善,无伸直受限,后抽屉试验、反轴移试验均为阴性,Lyshlom评分由术前（47.71±5.99）分提高到术后（82.29±2.50）分。未发生并发症。结论关节镜下LARS重建PCL操作简便、创伤小,术后能早期功能锻炼,近期疗效满意,是目前临床应用效果理想的人工韧带。     

关节镜下LARS人工韧带重建后交叉韧带及有限切开重建外侧副韧带

目的探讨后交叉韧带、外侧副韧带同时损伤后,应用LARS人工韧带关节镜下重建后交叉韧带并同时有限切开重建外侧副韧带的手术方法。方法8例关节镜下LARS人工韧带重建后交叉韧带同时有限切开LARS人工韧带重建外侧副韧带。术后随访6~29个月,采用国际膝关节委员会韧带标准评价表(IKDC)和Lysholm膝关节功能评分表评估患膝功能。结果术后无膝关节感染发生,无伸膝受限,屈膝活动度115~125°,术后随访时IKDC评分:8例均为A类,患者术前Lysholm膝关节功能评分平均为60分以下,终末随访时为平均91·5分。结论膝关节后交叉韧带、外侧副韧带同时损伤,较为少见,采用自体或异体移植物等方法重建创伤大,移植物来源有限,术后并发症多,膝关节术后不能达到即时稳定,易导致术后再次发生膝关节不稳。而应用LARS人工韧带关节镜下重建后交叉韧带,同时重建外侧副韧带,术后膝关节可获得即时稳定,利于膝关节早期活动,避免相关并发症的发生,临床疗效满意。     

Die mediale OSG Instabilität

The deltoid ligament is the primary stabilizer of the ankle joint. Injuries of the deltoid ligament are more frequent than assumed but still are often missed. Inadequate treatment can lead to chronic pain, instability and ankle arthritis. The deltoid ligament is strongly connected to the spring ligament. Patient history and clinical assessment as well as magnetic resonance imaging help identify the injured structures. Treatment options range from immobilization in a cast to ligament reconstruction using a free tendon.     

LARS人工韧带在前交叉韧带重建中的作用

目的 探讨LARS人工韧带在前交叉韧带损伤移植重建中的应用。方法 以2004年8月至2006年1月间因前交叉韧带损伤行LARS人工韧带重建手术的18例患者为对象进行回顾性研究。结果 随访6～24个月，平均13个月，所有患者膝不稳症状消失，前抽屉试验阴性，关节功能良好。平均伸屈度0°～（130±10．2341）°。根据Lysholm膝关节评分法，平均积分由术前的（45．2±1．2315）分提高到术后的（85．5±2．3317）分，二者间差异有显著性意义。结论 用LARS人工韧带重建前交叉韧带早期恢复效果满意，特别适合于运动员的前交叉韧带损伤。     

Adding deltoid ligament repair in ankle fracture treatment: Is it necessary? A systematic review

BackgroundDeltoid ligament injuries are typically caused by supination-external rotation or pronation injury. Numerous ligament reconstruction techniques have been proposed; however, clear indications for operative repair have not yet been well established in the literature.MethodsWe reviewed primary research articles comparing ORIF treatment for ankle fracture with versus without deltoid ligament repair.ResultsFive studies were identified with a total of 281 patients. 137 patients underwent ORIF with deltoid repair, while 144 patients underwent ORIF without deltoid ligament repair. Clinical, radiographic, and functional outcomes, as well as complications were considered. The average follow-up was 31 months (range, 5–120).ConclusionsCurrent literature does not provide clear indication for repair of the deltoid ligament at the time of ankle fracture repair. There may be some advantages of adding deltoid ligament repair for patients with high fibular fractures or in patients with concomitant syndesmotic fixation.Level of clinical evidence: III.     

Hybrid Anterior Cruciate Ligament Reconstruction: Introduction of a New Technique for Anatomic Anterior Cruciate Ligament Reconstruction

Recently, anatomic or double-bundle reconstruction of the anterior cruciate ligament (ACL) has been presented in an effort to more accurately restore the native anatomy. These techniques create 2 tunnels in both the femur and tibia to reproduce the bundles of the ACL. However, the increased number of tunnels, particularly on the femoral side, has raised some concerns among authors and surgeons. We describe a technique to reconstruct the 2 distinct bundles of the ACL by using a single femoral tunnel and 2 tibial tunnels, the “hybrid” ACL reconstruction. The femoral tunnel is drilled through an anteromedial arthroscopy portal, which allows placement in a more anatomic position. Fixation in the femur is achieved with a novel device that separates a soft-tissue graft into 2 independently functioning bundles. Once fixed in the femur, the anteromedial and posterolateral bundles of the graft are passed through respective tunnels at the anatomic footprint on the tibia. These bundles are independently tensioned, which creates a reconconstruction that is similar to the native ACL. The technique presented provides surgeons with an alternative to other double-bundle techniques involving 4 tunnels.     

The intrinsic subtalar ligaments have a consistent presence,location and morphology

BackgroundChronic subtalar instability is a disabling complication after acute ankle sprains. Currently, the literature describing the anatomy of the intrinsic subtalar ligaments is limited and equivocal which causes difficulties in diagnosis and treatment of subtalar instability. The purpose of this study is to assess the anatomical characteristics of the subtalar ligaments and to clarify some points of confusion.MethodsIn 16 cadaveric feet, the dimensions and locations of the subtalar ankle ligaments were assessed and measured. CT-scans before dissection and after indication of the footprints with radio-opaque paint allowed to generate 3D models and assess the footprint characteristics.ResultsThe cervical ligament (CL) had similar dimensions as the lateral ligaments: anterior length 13.9 ± 1.5 mm, posterior length 18.5 ± 2.9 mm, talar width 13.6 ± 2.2 mm, calcaneal width 15.8 ± 3.7 mm. The anterior capsular ligament (ACaL) and interosseous talocalcaneal ligament (ITCL) were found to be smaller structures with consistent dimensions and locations.ConclusionThis study identified consistent characteristics of the intrinsic subtalar ligaments and clarifies the local anatomical situation. The dimensions and footprints of the intrinsic ligaments of the subtalar joint suggest a more important role of the CL and ACaL in the stability of the subtalar joint. The results of this study are relevant to improve diagnostic tools and offer some guidelines when reconstructing the injured ligaments.