关节镜下胫骨端RigidFix、股骨端IntraFix固定技术重建后交叉韧带

目的探讨胫骨端RigidFix和股骨端IntraFix固定重建技术治疗后交叉韧带损伤的临床疗效。方法2007年3月-2010年3月，采用同种异体胫前肌腱为移植物重建后交叉韧带35例，男27例，女8例。年龄25—42岁，平均32．5岁。左膝12例，右膝23例。移植物胫骨端以RigidFix横穿钉固定，股骨端以Intra Fix挤压螺钉固定。术后通过体格检查、Lysholm评分及国际膝关节文献管理委员会（International Knee Documentation Committee，IKDC）评分来评价手术疗效。结果所有手术成功，无骨折或定位偏离等并发症。术后随访24～60个月，平均35．3月。末次随访时35例胫骨下陷征均为阴性；Lachman征阴性33例，I度阳性2例；后抽屉试验阴性31例，I度阳性3例，Ⅱ度阳性1例。Lysholm评分85．0±4．5（80～98）分，优9例，良25例，中1例。IKDC评分85．1±2．6（81～95）分，A级9例，B级26例。上述指标均较术前明显改善。结论胫骨端RigidFix和股骨端IntraFix固定重建后交叉韧带时不用顾忌移植物长度限制，操作简单；中心固定不会影响移植物的位置，可避免对移植物造成切割，避免干扰腱骨界面。此项技术切实可行、固定可靠，且不易发生并发症，疗效优良。

Arthroscopic Posterior Cruciate Ligament Reconstruction with Tibiai RigidFix and Femoral Intra Fix Fixation

Objective To evaluate the clinical effect of arthroscopic posterior cruciate ligament reconstruction with tibial RigidFix and femoral IntraFix fixation. Methods Between March 2007 and March 2010, 35 patients underwent arthroseopic posterior eruciate ligament reconstruction with allograft of anterior tibialis tendon. There were 27 male and 8 female patients, with an average age of 32.5 years, involving 12 left and 23 right knee joints. The graft was fixed with RigidFix on the tibial side and IntraFix on the femoral side. Clinical results were evaluated according to postoperative physical examination, Lysholm knee score and International Knee Documentation Committee （IKDC） score. Results All surgeries were successful without complications such as neurovascular injuries and infection. All cases were followed up for 24 -60 months （average, 35.3 months）. In the last follow-up, no positive Sag sign was shown in any patient; Laehman test showed negative results in 33 patients and limited in grade I of laxity in 2 patients; posterior drawer test showed negative results in 31 patients, limited in grade I of laxity in 3 patients and grade It in 1 patient. Lysholm scores of the 35 cases were 85.0 ± 4.5 （80 - 98） in the last follow-up, with 9 cases being excellent, 25 cases being good and 1 case being medium. KDC scores were 85.1 ±2.6 （81 -95） in the last follow-up, with A in 9 cases and B in 26 cases. All the scores improved significantly as compared to preoperative ones. Conclusions The application of transtibial posterior crueiate ligament reconstruction with the use of RigidFix in tibial side is simple and feasible, without consideration of graft length. Less complications occur. The use of IntraFix technique for femoral fixation does not interfere with the tendon-bone interface,thus reducing the graft wear.