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1.
关节镜下LARS人工韧带重建后交叉韧带   总被引:12,自引:2,他引:10  
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。  相似文献   

2.
关节镜下LARS重建后交叉韧带的近期疗效   总被引:4,自引:1,他引:3  
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。  相似文献   

3.
关节镜内人工韧带治疗后十字韧带损伤的初步报告   总被引:12,自引:1,他引:11  
目的 探讨关节镜内人工韧带重建后十字韧带临床应用疗效。方法 选择11例膝后十字韧带断裂患者,由同一组医师在关节镜内行Gore-Tex人工韧带重建后十字韧带,手术前后进行膝关节症状、后抽屉试验、Lachman试验的比较。结果 术后随访2~30个月,平均18个月,采用Lysholm膝关节评分法评估,平均得分由术前43分提高到术后91例。结论 后十字韧带断裂并发关节不稳定应该进行重建手术。 与前十字韧带  相似文献   

4.

Introduction

Surgical reconstruction has been increasingly recommended for the surgical management of posterior cruciate ligament (PCL) ruptures. While the choice of tissue graft still remains controversial. Currently both hamstring tendon autograft (HTG) and ligament advanced reinforcement system (LARS) artificial ligament are widely used but there are seldom reports on the comparisons of their clinical results. Our study was aimed to assess the effectiveness of these two grafts.

Materials and methods

Thirty-five patients with unilateral PCL rupture were enrolled in this retrospectively study. Sixteen of them received arthroscopically assisted PCL reconstruction using hamstring tendon autografts (HTG group) and nineteen using LARS ligaments (LARS group). All cases were followed up for 46–57 months with a mean of 51 months. Follow-up examinations included radiographic assessment, Lysholm score, Tegner score, International Knee Documentation Committee (IKDC) rating scales and KT-1000 test.

Results

All patients improved significantly at the final follow-up compared with the examinational results preoperatively and there were no significant differences between HTG group and LARS group with respect to the results of radiographic assessment, Lysholm score, Tegner score, IKDC rating scales and KT-1000 test.

Conclusions

Similar good clinical results were obtained after PCL reconstruction using hamstring tendon autografts and LARS ligaments. Both LARS ligament and hamstring tendon autograft are ideal grafts for PCL reconstruction.  相似文献   

5.
关节镜下膝关节前、后交叉韧带重建53例   总被引:3,自引:0,他引:3  
目的总结关节镜下前、后交叉韧带(ACL、PCL)及膝内外侧复合体重建的经验。方法关节镜下移植中1/3骨-髌腱-骨组织、4股腘绳肌腱及LARS人工韧带重建膝关节ACL、PCL。合并膝内、外侧结构损伤患者在重建的同时进行膝关节侧副韧带和关节囊的修补。术后佩戴可调式膝关节固定带3个月行康复训练。结果53例随访2个月~5年4个月,Lysholm评分由术前平均(20±4.6)分提高到(85±7.3)分。所有患者术前抽屉试验及Lachman试验存在阳性体征,术后1例后抽屉试验阳性,4例Lachman试验弱阳性。所有患者关节功能明显改善。结论在关节镜直视下交叉韧带重建能准确定位ACL、PCL解剖止点,具有损伤小,关节粘连率低,恢复快的优点,能达到坚强固定,早期功能锻炼的目的。  相似文献   

6.
Wang CJ  Weng LH  Hsu CC  Chan YS 《Injury》2004,35(12):1293-1299
This prospective study compared the clinical results of single- and double-bundle posterior cruciate ligament (PCL) reconstruction with a minimum follow-up of 2 years. There were 35 patients including 19 single- and 16 double-bundle posterior cruciate ligament reconstructions using hamstring autograft. The average age was 29.4±13.6 years versus 28.2±10.4 years; and the average follow-up was 41.0±13.1 months versus 28.2±4.2 months for single- and double-bundle reconstruction, respectively. The indication for surgery was functional disability of the knee due to pain and instability as the result of high-energy PCL injury. The evaluation parameters included functional assessment, ligament laxity, functional score and radiographs of the knee. The results showed no significant difference in functional assessment, ligament laxity, functional score and radiographic changes of the knee between the two techniques. The rate of overall satisfaction with the operation was comparable from patient and surgeon perspectives. Contrary to many recent reports, the results of this study showed that single- and double-bundle PCL reconstruction using hamstring autograft produced comparable clinical results in medium-term follow-up. The difference between single- and double-bundle PCL reconstruction, if any, can be concluded only with long-term results and larger number of patients.  相似文献   

7.
目的探讨关节镜下一期应用自体腘绳肌腱重建前交叉韧带联合LARS人工韧带重建后交叉韧带的临床疗效。方法自2009-02—2010-06对14例膝关节前、后交叉韧带断裂及严重膝关节脱位患者在关节镜下一期采用自体腘绳肌腱重建前交叉韧带联合LARS人工韧带重建后交叉韧带,同时处理合并的侧副韧带及半月板损伤。末次随访时采用膝关节Lysholm评分、IKDC评分评定疗效。结果术后14例均获随访23~36个月,平均29.5个月。均无膝关节肿痛症状、感染、伸膝障碍发生。末次随访时,膝关节屈曲达120°~130°;膝关节IKDC评分:A类11例(78.6%),B类2例(14.3%),C类1例(7.1%);膝关节Lysholm评分(89.2±4.6)分,较术前(54.7±5.3)分明显提高,差异有统计学意义(t=32.156,P=8.91E-14)。结论关节镜下一期应用自体腘绳肌腱重建前交叉韧带联合LARS人工韧带重建后交叉韧带治疗膝关节多韧带损伤临床疗效满意。  相似文献   

8.
关节镜下人工韧带移植重建膝前后交叉韧带   总被引:1,自引:0,他引:1  
目的回顾性研究关节镜下应用人工韧带重建膝交叉韧带的疗效。方法应用LARS人工韧带对16例交叉韧带损伤行关节镜下重建,术后予以早期康复锻练,对临床疗效进行回顾性分析。结果手术时间55~96min,平均65min。16例均随访3~30个月,平均16个月。术后无滑膜炎、韧带断裂、活动受限等并发症。按照IKDC评分标准及Lysholm膝关节功能评分进行评估,术后膝关节功能均得到良好恢复。结论LARS人工韧带的应用能避免取材部位的并发症,操作简便,可早期康复锻炼,极好的恢复关节屈伸度,获得满意疗效。  相似文献   

9.
This study compares the results of arthroscopic transtibial tunnel single-bundle and double-bundle posterior cruciate ligament (PCL) reconstructions using allograft tissue in PCL-based multiple ligament injured knees. Ninety consecutive PCL reconstructions are evaluated: 45 single-bundle and 45 double-bundle reconstructions. All PCL reconstructions were performed using the arthroscopically assisted transtibial tunnel PCL reconstruction technique using fresh frozen allograft tissue from the same tissue bank. Achilles tendon allograft was used for the anterolateral bundle; tibialis anterior allograft was used for the posteromedial bundle. The knees were evaluated postoperatively, comparing the single-bundle results to the double-bundle results, with KT-1000 arthrometer (Medmetric Corporation, San Diego, CA) testing, three different knee ligament rating scales, and Telos stress radiography (Austin Associates, Fallston, MD). Both the single-bundle and the double-bundle PCL reconstruction surgical techniques using allograft tissue provide successful results in the PCL-based multiple ligament injured knee when evaluated with stress radiography, arthrometer measurements, and knee ligament rating scales.  相似文献   

10.
 目的 探讨腓骨长肌腱前半部(anterior half of the peroneus longus tendon,AHPLT)作为自体肌腱移植材料重建膝关节韧带的可行性及疗效。方法 2007年7月至2008年1月采用AHPLT作为自体肌腱移植材料的膝关节韧带损伤患者100例,男33例,女67例;年龄16~62岁,平均32.3岁。关节镜下内侧髌股韧带重建49例、多条韧带重建19例、后十字韧带双束重建18例和前十字韧带双束重建14例。切取AHPLT作为全部(49例)或部分(51例)重建材料,采用单切口或双切口技术,重建韧带用螺钉挤压固定。术后评估膝关节Kujala评分、Lysholm评分、Marx评分、国际膝关节文献委员会(International Knee Documentation Committee,IKDC)膝关节主观评估表和客观等级评定、踝关节足踝功能障碍指数(Foot and Ankle Disability Index,FADI)及美国足踝外科学会(American Orthopedic Foot and Ankle Society,AOFAS)评分。结果 92例获得2年以上随访。术后2年,不同韧带重建组患者膝关节IKDC主观评分、Kujala评分、Lysholm评分及Marx评分均高于重建术前。多条韧带重建、后十字韧带双束重建和前十字韧带双束重建术后IKDC客观等级评定结果达到正常及接近正常者分别为17例、15例和12例,优良率分别为89.5%(17/19)、93.7%(15/16)和100%(12/12)。全部患者手术前后AOFAS评分分别为(97.4±2.0)分和(97.2±1.6)分,FADI评分分别为(96.8±2.2)分和(96.9±2.5)分,差异均无统计学意义。患者均未出现腓神经损伤、腓骨长肌腱断裂等并发症。结论 AHPLT作为自体肌腱移植材料重建膝关节韧带具有操作可行性,近期临床疗效好,切取肌腱后对踝关节功能影响小。  相似文献   

11.
目的研究膝关节镜下保留残存后交叉韧带(PCL)纤维结合7股自体腘绳肌腱单束重建PCL的临床效果。方法对13例PCL损伤,采用胫骨隧道技术结合7股自体腘绳肌腱进行单束重建,术中保留残存PCL纤维,移植物使用悬吊式固定,手术前后采用Lysholm膝关节功能评价表和Tegner下肢运动能力评价表进行评估,并了解患者膝关节的稳定性、活动度。结果所有患者随访12~36个月,术前和术后12个月Lysholm评分分别为(50.20±8.32)分和(87.23±4.20)分(P<0.05),Tegner评分分别为(2.03±0.33)分和(4.11±0.13)分(P<0.05)。术后12个月后抽屉试验阴性7例,Ⅰ度阳性5例,Ⅱ度阳性1例,所有患膝运动能力均较术前有所改善。结论关节镜下采用经胫骨隧道技术保留残存纤维结合7股自体腘绳肌腱单束重建PCL是一种恢复膝关节稳定性和功能的可靠方法。  相似文献   

12.
目的观察内侧髌股韧带重建联合胫骨结节移位和关节镜下外侧支持带松解术治疗持久性髌骨脱位的效果。方法对6例持久性髌骨脱位患者的10个膝关节行内侧髌股韧带重建联合胫骨结节移位和关节镜下髌骨外侧支持带松解术。手术前后采用Lysholm膝关节功能评价表和Kujala评分表进行评估,并通过CT观测手术前后髌骨外移度。结果 6例均获随访,时间24~36(29±7.21)个月。Lysholm评分术前为47.10分±10.31分,术后24个月为83.11分±5.21分,差异有统计学意义(P<0.05);Kujala评分术前为41.26分±13.36分,术后24个月为82.33分±5.31分,差异有统计学意义(P<0.05)。患膝运动能力均较术前明显改善。髌骨外移度术前为35.61 mm±5.37 mm,术后为4.30mm±1.13mm,差异有统计学意义(P<0.05)。结论内侧髌股韧带重建联合胫骨结节移位和关节镜下髌骨外侧支持带松解术能够有效纠正持久性髌骨外侧脱位,缓解症状,恢复膝关节功能。  相似文献   

13.
We have undertaken a randomised clinical trial comparing two methods of reconstruction of the anterior cruciate ligament in patients with chronic instability. We used an ipsilateral bone-patellar-tendon-bone autograft in 27 patients and the Ligament Advancement Reinforcement System (LARS) artificial ligament in 26. Assessment before and at two, six, 12 and 24 months after surgery, included the history, physical examination, a modified International Knee Documentation Committee (IKDC) score, the Tegner score, the Knee Injury and Osteoarthritis Outcome Score (KOOS) and instrumented laxity testing. There were no cases of reactive synovitis or of infection of the knee, and there was no difference regarding the failure rate between the two groups. The IKDC showed no significant differences between the two groups at any stage of the follow-up. The KOOS evaluation showed consistently better results in all subscales for the LARS group during the first year of follow-up. After 24 months these differences were no longer evident. Instrument-tested laxity was greater in the LARS group at all stages of follow-up, but the differences were not significant at 24 months. Our findings suggest that at follow-up at 24 months the LARS ligament seems to be a satisfactory treatment option, especially when an early return to high levels of activity is demanded.  相似文献   

14.
Li B  Wen Y  Wu H  Qian Q  Wu Y  Lin X 《International orthopaedics》2009,33(4):991-996
Our objective was to compare the results of reconstruction of isolated chronic posterior cruciate ligament (PCL) injury using a four-strand hamstring graft (4SHG) and a LARS artificial ligament. Thirty-six patients were divided into a 4SHG group (n = 15) and a LARS group (n = 21). The minimum follow-up time was two years. The outcome measures used were KT-1000 measurements, the International Knee Documentation Committee (IKDC) scoring system, Lysholm knee scoring scale and Tegner activity rating. Both groups improved significantly between the preoperative and postoperative assessment in terms of the knee laxity and functional examination (P < 0.01). Meanwhile, knee stability was significantly improved in the LARS group when compared with the 4SHG group (P < 0.05); this was also the case for the Lysholm, Tegner and IKDC scores (P < 0.05). Our study indicates that using a LARS ligament for PCL reconstruction was clinically more useful than using a 4SHG in the treatment of the PCL-deficient knee.
Résumé  Le but de cette étude est de comparer les résultats de la reconstruction des ruptures isolées du ligament croisé postérieur soit par un greffon provenant des ischio-jambiers avec 4 bandes (SHG) soit par un ligament artificiel (LARS). Matériel et méthode: 36 patients ont été divisés en deux groupes, groupe de 15 patients traité par greffe des ischio-jambiers et groupe de 21 patients traités par ligament artificiel LARS. Le suivi minimum a été de deux ans. Les résultats ont été évalués avec le KT-1000, avec le score IKDC et le score de Lysholm ainsi que l’activité de type Tegner. Résultats: dans les deux groupes l’amélioration est significative entre l’état pré-opératoire et l’état post-opératoire, en termes de laxité et d’examens fonctionnels (p < 0,01). Cependant la stabilité est nettement améliorée dans le groupe du ligament artificiel (p < 0,05) aussi bien pour le test de Lysholm, le score IKDC que Tegner (p < 0,05). En conclusion notre étude montre que l’utilisation du ligament artificiel de type LARS pour la reconstruction des lésions du ligament croisé postérieur peut être plus efficace que l’utilisation d’une greffe de quatre bandes issues des muscles ischio-jambiers.
  相似文献   

15.
目的 评价关节镜下应用异体跟腱股骨双束双隧道同时重建后交叉韧带与前交叉韧带的临床疗效.方法 14例前、后交叉韧带损伤患者在关节镜下应用异体跟腱同时重建前、后交叉韧带,且后交叉韧带股骨侧应用双束双隧道重建.受伤至手术时间平均19.5 d.术后平均随访34.5个月.采用Lysholm评分和Tegner评分对患膝功能进行评估,通过KT-1000检查膝关节的前后松弛度.术前患者屈膝活动度(123.6±2.5)°,Lysholm评分(52.8±2.2)分,伤前Tegner评分平均为(5.9±0.5)分,术前为(1.2±0.9)分.结果 术后患者屈膝活动度(117.9±2.8)°,与术前比较差异无统计学意义(t=1.54,P=0.14).术后Lachman试验阴性者13例(92.9%),后抽屉试验阴性者12例(85.7%).KT-1000屈膝25°双侧胫骨前后松弛度差值在2 mm以内9例,3~5 mm 4例,6 mm1例.屈膝70°差值2 mm以内10例,3~5 mm 3例,6 mm 1例.Lysholm评分术后提高至(92.9±3.3)分,差异具有统计学意义(t=17.009,P<0.001).术后Tegner评分终末随访时平均为(5.4±0.8)分.手术前后的差异有统计学意义(F=4.2,P<0.01).11例恢复到受伤前运动水平(78.6%),另外3例运动水平较受伤前有所降低.结论 关节镜下应用异体跟腱股骨双束双隧道同时重建后交叉韧带与前交叉韧带,后交叉韧带股骨侧应用双束双隧道重建,更接近后交叉韧带解剖重建,能够恢复膝关节的稳定性,较满意地恢复膝关节功能.  相似文献   

16.
目的 探讨单隧道双束腘绳肌腱双Intrafix固定重建前交叉韧带(ACL)中应用的可行性及近期疗效.方法 对30例ACL损伤患者行关节镜下单隧道双束腘绳肌腱ACL重建术.采用膝关节镜前内侧入路(AM)建立股骨隧道,胫骨端用点对点ACL瞄准器建立隧道.隧道股骨端采用Femoral-Intrafix固定将腘绳肌腱分为前内侧束及后外侧束.通过旋转胫骨端移植物,将移植物调整为生理的双束位置,采用Bio-Intrafix固定胫骨端.结果 30例均获随访,时间6~8个月.根据Lysholm膝关节功能评分:术前为19~58(33.17±11.71)分;术后6个月为88~98(95.30±2.10)分(t=30.20,P<0.01).结论 单隧道双束腘绳肌腱双Intrafix固定重建ACL,手术操作简便,固定牢固,近期效果满意.  相似文献   

17.
张磊  刘劲松  孙晋  李智尧  马佳 《中国骨伤》2008,21(12):890-893
目的:探讨关节镜下同种异体跟腱重建后交叉韧带(PCL)的方法,验证股骨双柬双隧道、胫骨Inlay技术重建PCL的临床疗效。方法:2005年9月至2007年8月,采用经深低温冷冻及γ射线照射处理后的异体跟腱对10例PCL损伤的患者行关节镜下PCL重建术,手术方式股骨端为双束双隧道重建,可吸收挤压螺钉固定,胫骨端为Inlay固定。通过物理检查、Lysholm及IKDC评分来评价手术疗效。结果:术后8d内患者体温恢复正常,免疫排斥轻,无感染发生。所有患者术后获6~23个月(平均17个月)随访,终末随访时10例患者术膝胫骨下陷征(Sagsign)阴性,后抽屉试验(PDT)及Lachman征均为阴性或I度。疗效评定采用Lysholm评分和IKDC评分。Lysholm评分中交锁、不稳、疼痛、肿胀、爬楼、下蹲和总分术前术后比较差异有统计学意义,术后优7例,良2例,中1例;IKDC评分中疼痛频率、疼痛程度、规律活动量、活动影响程度、功能自评和总分等术前术后比较差异有统计学意义,术后IKDC评分A级7例,B级3例。结论:同种异体跟腱是重建PCL的可靠替代物,双束双隧道和Inlay技术固定可靠,可减少移植物损伤,是PCL重建的理想技术。  相似文献   

18.
目的 比较关节镜下应用先进人工韧带加强系统(ligament advanced reinforcement system,LARS)和4股自体半腱肌腱重建膝关节前交叉韧带(anterior cruciate ligament,ACL)的疗效,探讨LARS重建ACL的临床效果.方法 2002年7月-2005年4月,分别采用LARS和4股自体半腱肌腱于关节镜下重建42例ACL断裂患者.半腱肌腱组(27例):男22例,女5例;年龄20~52岁.运动伤12例,交通伤8例,其他损伤7例.左膝16例,右膝11例.Lysholm膝关节评分为(50.70 ±6.68)分.病程2~12个月.LARS组(15例):男12例,女3例;年龄17~40岁.运动伤8例,交通伤4例,其他损伤3例.左膝6例,右膝9例.Lvsholm膝关节评分为(50.20±6.22)分.病程3~12个月.两组患者间各项指标差异均无统计学意义(P>0.05).结果 两组患者术后伤口均Ⅰ期愈合,无并发症发生.半腱肌腱组均获随访22~43个月,LAPS组均获随访18~40个月.术后12个月,半腱肌腱组5例(19%)患者屈膝30°时双膝差距>3 mm;LARS组3例(20%)>3 mm.半腱肌腱组Lysholm评分(87.80±3.41)分;LARS组为(88.90±3.30)分,组间差异无统计学意义(P>0.05).参考Cameron等改良Lysholm评分的分级标准,半腱肌腱组:优18例,良7例,可2例,优良率为92.6%;LARS组优11例,良3例,可1例,优良率为93.3%;组间差异无统计学意义(P>0.05).Tegner运动评级标准:半腱肌腱组3~6级,平均4.93级;LARS组3~7级,平均5.03级;组间差异无统计学意义(P>0.05).半腱肌腱组中2例伸膝角度较对侧差约5°,5例屈膝较对侧差5~10°;LARS组患者关节活动度均恢复正常;组间差异有统计学意义(P<0.05).两组患者均未出现急慢性滑膜炎表现.结论 LARS重建ACL可取得与4股自体半腱肌腱相同的近期疗效,且明显缩短康复时间,随访2年未发现移植术后有滑膜炎等不良反应发生.  相似文献   

19.
The optimized graft for use in anterior cruciate ligament (ACL) reconstruction is still in controversy. The bone–patellar tendon–bone (BPTB) autograft has been accepted as the gold standard for ACL reconstruction. However, donor site morbidities cannot be avoided after this treatment. The artificial ligament of ligament advanced reinforcement system (LARS) has been recommended for ACL reconstruction. The purpose of this study is to compare the midterm outcome of ACL reconstruction using BPTB autografts or LARS ligaments. Between July 2004 and March 2006, the ACL reconstruction using BPTB autografts in 30 patients and LARS ligaments in 32 patients was performed. All patients were followed up for at least 4 years and evaluated using the Lysholm knee score, Tegner score, International Knee Documentation Committee (IKDC) score, and KT-1000 arthrometer test. There were no significant differences between the two groups with respect to the data of Lysholm scores, Tegner scores, IKDC scores, and KT-1000 arthrometer test at the latest follow-up. Our study demonstrates that the similarly good clinical results are obtained after ACL reconstruction using BPTB autografts or LARS ligaments at midterm follow-up. In addition to BPTB autografts, the LARS ligament may be a satisfactory treatment option for ACL rupture.  相似文献   

20.
目的:观察关节镜下保留残端单束重建后交叉韧带(posterior cruciate ligament, PCL)的临床疗效。方法回顾性分析自2010年1月至2013年1月对18例PCL损伤患者在我院行关节镜下保留残端PCL单束重建术。记录并比较患者的Lysholm和国际膝关节文献委员会膝关节评估表(International Knee Documentation Committee, IKDC)评分。结果本组患者随访时间24~42个月,平均31.2个月。患者均未发生严重并发症。患者膝关节Lysholm评分由术前的(58.4±4.5)分提高到术后的(91.6±3.1)分,差异有统计学意义(P<0.05)。IKDC评分由术前的(52.1±7.6)分提高到术后的(88.3±6.2)分,差异有统计学意义(P<0.05)。结论关节镜下保留残端单束重建PCL术后临床疗效良好,功能满意。  相似文献   

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