三明治式后十字韧带重建的临床疗效

目的 评估后十字韧带三明治式重建,即保留残存纤维,采用八股腘绳肌腱双束重建后十字韧带的效果.方法 2005年1月至2005年6月,单纯陈旧性后十字韧带损伤患者18例,男14例,女4例;年龄19～42岁,平均34岁.在关节镜下采用自体腘绳肌腱行双束四隧道重建,其中采用四股半腱肌腱重建前外侧束,四股股薄肌腱重建后内侧束.残存纤维保留于重建的双柬移植物之间.通过微型钢板和纽扣悬吊式固定移植物.根据IKDC、Lysholm和Tegner评分标准进行评估.结果 患者均获得2年以上随访,末次随访时发现,17例患者(94.4%)后抽屉试验阴性,1例后抽屉试验1度阳性.KT-1000检查示,双膝后向松弛度差值从术前的(9.3±1.4)mm改善为术后的(0.7±0.9)mm,两者比较差异有统计学意义(P＜0.01).根据IKDC评估标准,16例患者(88.9%)评级正常,2例患者(11.1%)评级接近正常.IKDC主观评分从(64.1±3.3)分增加到(95.6+3.1)分(P＜0.01).Lysholm评分从(58.6+4.4)分增加到(94.9±3.6)分(R＜0.01).Tegner评分,术前为5.6分,末次随访时为6.9分.结论 关节镜下后十字韧带三明治式重建能使88.9%的患者在术后2年得到正常的IKDC评级,11.1%的患者得到接近正常的IKDC评级.

Clinical effect of the sandwich style posterior cruciate figament reconstruction

Objective To evaluate the results of the sandwich style posterior cruciate ligament (PCL) reconstruction,namely two-bundle PCL reconstruction with eight-strand of hamstring tendons and remnant preservation.Methods From January 2005 to June 2005,18 patients suffered isolated chronic PCL ruptures invovled in this study,which included 14 males,4 females,with the mean age of 34 years (range,19-42 years).All patients underwent PCL arthroscopical reconstructions with eight-strand of autogenous hamstring tendons in a two-bundle and four-tunnel manner,and with preservation of the remnant in between the two reconstructed bundles as well.Quadruple-stranded semitendinous tendon was used to reconstruct the anterolateral bundle,and quadruple-stranded gracilis tendon was used to reconstruct the posteromedial bundle.The grafts were fixed with a suspension technique using mini-plates and mini-buttons.The patients were followed up for a minimum of two years and evaluated according to the IKDC,Lysholm and Tegner rating scale.Results At the final follow-up,posterior drawer test showed negative in 17(94.4%) patients; while positive in 1 patient.The average KT-1000 examination results changed from (9.3+1.4) mm preoperatively to (0.7+0.9) mm postoperatively (P＜ 0.01).According to the IKDC knee examination form,16 patients (88.9%) were graded normal,2 patients (11.1%) were graded nearly normal.The IKDC subjective resuits increased from 64.1 +3.3 to 95.6+3.1 (P＜ 0.01),and the Lysholm score increased from 58.6+4.4 to 94.9+3.6 (P＜ 0.01).The average Tegner score was 5.6 before surgery and 6.9 at the final follow-up.Conclnsion Arthroseopic sandwich style PCL reconstruction can get 88.9% normal and 11.1% nearly normal IKDC results at a minimum of two years.