关节镜下自体腘绳肌腱双束解剖重建前交叉韧带的临床疗效

目的:探讨膝关节镜下应用自体腘绳肌腱双束解剖重建前交叉韧带的临床疗效。方法:自2009年4月至2010年3月,诊断前交叉韧带损伤25例。男13例,女12例;平均年龄25.8岁(17～43岁);运动损伤17例,意外摔伤6例,交通事故伤2例;平均病程3个月。8例慢性损伤患者均以膝关节不稳为主诉,急性损伤及亚急性损伤患者多以膝关节肿痛为主诉。术前轴移试验阳性15例,Lachman试验阳性25例,前抽屉试验阳性25例。KT2000仪器测量胫骨前移度比健侧增加(7.1±2.4)mm,Lysholm评分平均(40.0±5.4)分,Tegner运动功能评分平均(3.2±0.7)分。在关节镜下以自体腘绳肌腱双束解剖重建前交叉韧带,分别于前交叉韧带股骨及胫骨附着处建立2个骨隧道,重建前交叉韧带的前内束及后外束;股骨侧以纽扣钢板悬吊固定,胫骨侧以干涉螺钉及拴桩双固定。术后进行随访,观察患者症状体征变化,测量患者胫骨前移度,并以Lysholm评分和Tegner评分评价术后膝关节功能。结果:患者术后均获2年以上随访,时间24～35个月,平均27个月。术后25例术膝轴移试验均阴性;Lachman征阴性23例,Ⅰ度阳性2例,术前术后差异有统计学意义。前抽屉试验阴性21例,Ⅰ度阳性3例,Ⅱ度阳性1例,术前术后差异有统计学意义。KT2000仪器测量患膝胫骨前移度,术后比健侧增加(2.0±0.5)mm(0～4mm),术后平移度较术前减小(t=22.35,P=0.0001);术后Lysholm评分平均(85.0±4.5)分(80～98分),术后评分较术前提高(t=17.64,P=0.001);术后Tegner运动功能评分平均(7.5±0.2)分(6～9分),术后评分较术前提高(t=8.12,P=0.0005)。术后患者膝关节运动功能改善。结论:自体腘绳肌腱双束解剖重建前交叉韧带术后轴移试验为阴性,能有效地恢复膝关节前向及旋转稳定性。双束重建术后膝关节功能恢复良好,膝关节运动功能基本恢复正常。

Double-bundle reconstruction of anterior cruciate ligament using hamstring auto graft under arthroscopy

Objective:To evaluate the clinical effects of double-bundle reconstruction of anterior cruciate ligament (ACL) using hamstring tendon auto graft under arthroscopy. Methods:From April 2009 to March 2010,25 patients(13 males and 12 females) with ACL deficiency were treated with arthroscopy,ranging in age from 17 to 43 years,with an average of 25.8 years. There were 17 patients caused by sports injuries,6 patients caused by accidental falling,and 2 patients caused by traffic injury. The average duration of the disease was 3 months. The main symptom was knee instability in 8 patients,and knee pain and swelling in other patients. Pivot shift test was positive in 15 cases,and Lachman test was positive in 25 cases,the ADT (anterior drawer test) was positive in 25 cases. The anterior transition of the tibia measured by KT2000 instrument was(7.1±2.4) mm more than the contralateral knee. The average Lysholm score was 40.0±5.4. The Tegner activity scores averaged 3.2±0.7. The double tibial tunnels and double femoral tunnels were drilled on the footprint of the ACL to reconstruct the anteromedial and posterolateral bundles under arthroscopy. Tendons were fixed with Endo-buttons at the femoral side and with biodegradable interference screw at the tibial side. Postoperative symptoms and signs were observed during follow-up period. The anterior transition of the tibia was measured by KT2000,and the Lysholm score and Tegner scores were used for evaluating knee function. Statistically analyzed was performed with SPSS 15.0. Results:All the patients were followed up,and the duration ranged from 24 to 35 months(averaged,27 months).At the latest follow-up,there was no positive pivot shift,while the Lachman test and ADT were negative or positive of grade I. The average Lysholm score of the 25 cases was 40.0±5.4 before operation,and 85.0±4.5 at the latest follow-up,3.2±0.7 before operation and 7.5±0.2 at the latest follow-up for Tegner activity score. Statistically,the difference between preoperative score and the postoperative score was significant. Conclusion:Double-bundle reconstruction of ACL with hamstring tauto graft under arthroscopy is effective and reliable to restore the stability of the knee,and the clinical effect is good to excellent.