胫骨-股骨单隧道双束解剖重建前交叉韧带

目的探讨胫骨-股骨单隧道双束重建前交叉韧带（ACL）的近期临床效果。方法对本组2009年4月至2011年4月收治的46例ACL损伤患者进行胫骨-股骨单隧道双束解剖重建ACL，先后钻取胫骨、股骨隧道，屈膝120。由前内侧入路建立股骨隧道，之后引入双束同种异体肌腱（或自体肌腱），肌腱胫骨端、股骨端（沿肌腱间打入钉鞘形成双束）固定，术后随访，按照IKDC和Lysholm膝关节评分标准评价疗效。结果所有患者均获得1年以上随访。最后随访时，所有患者前抽屉试验阴性，45例患者（97．8％）Lachman试验阴性，1例患者Lachman试验I度阳性。KT-1000检查显示双侧膝关节前向松弛度差值平均为（-0．47±1．39）mm，手术前后有统计学差异（t=36．07，P〈0．01）；其中30例（65．2％）〈0mm，即患侧关节稳定度高于健侧；15例（32．6％）为0～2mm；1例（2．1％）〉2mm。所有患者轴移试验检查均为阴性。活动度检查发现42例伸屈活动度均正常，1例有5。屈膝欠缺，1例患者有10。屈膝欠缺，2例有5。过伸欠缺。从膝关节稳定性方面分析，45例（97．8％）IKDC评级为正常，1例（2．2％）评级为接近正常。综合分析，44例（95．7％）IKDC评级正常，2例（4．3％）为接近正常。术后IKDC膝关节主观评分为（94．9±3．7）分，Lysholm评分为（93．71±3．3）分。受伤前Tegner评分平均为7．3分，最后随访时为6．9分。结论对膝关节ACL断裂患者施行胫骨一股骨单隧道双束解剖重建，能够建立具有高度稳定性的膝关节，使所有患者获得IKDC评级正常或者接近正常的结果。

Tibia-femur single-tunnel double-bundle anatomical reconstruction of anterior cruciate ligament

Objective To introduce the surgical technique about tibia-femur single tunnel double- bundle anatomical reconstruction of anterior cruciate ligament （ACL）, and to evaluate the short-term clinical results. Methods 46 cases of ACL injury went on tibia-femur single tunnel double-bundle anatomical reconstruction of ACL anterior cruciate ligament. The tunnels of tibia and femur were drilled one by one, then the tendon was pulled in. Both tibial and femoral tunnels were fixed by compression nail, which was screwed between the two bundles at femoral side. The patients were followed up for more than one year and evaluated according to IKDC and Lysholm rating scale. Results All the patients were followed up as scheduled. At the last follow-up, 45 patients （97.8%） had negative Lachman test results, and one patient had one degree of positive. KT-1000 examination showed that the average side-to-side difference of anterior laxity was （ - 0. 47±1.39 ） mm. 30 （65.2%） patients showed less than 0 mm laxity, which meant it was more stable than the normal side ; 15 （ 32. 6% ） patients showed 0 to 2 mm laxity; one patient showed more than 2 mm. All patients showed negative results in pivot shift test. 42 patients had normal range of motion; one patient had 5° flexion deficit and one had 10° flexion deficit; two patients had 5° hyperextension loss. As for the stability, 45 patients （97. 8% ） were graded as normal and one patient （2. 2% ） was graded as nearly normal according to the IKDC rating scale. Overall analysis showed that 44 patients （95.7%） were graded as normal and two patients （4. 3% ） were graded as nearly normal. The IKDC subjective score was （ 94. 9±3.7 ）, and the Lysholm score increased to （ 93.71± 3.3）. The average Tegner score was 7.3 before injury and 6. 9 at last follow-up. Conclusions Single- tunnel double-bundle anatomical reconstruction of anterior cruciate ligament could create a knee with hight stability, and result in normal or nearly normal IKDC scale for all patients.