关节镜下自体髌腱移植重建前交叉韧带的疗效观察

目的探讨使用自体骨-1/3髌腱-骨移植重建损伤的前交叉韧带(ACL)的临床疗效。方法本研究包括40例单纯性前交叉韧带断裂伴症状性胫骨前脱位的病例,均采用自体骨-1/3髌腱-骨重建。术后进行为期6个月的康复训练。术前和术后随访时行患侧膝关节X线检查,行体格检查及功能评分。结果总共36例(90%)获得随访,时间平均31个月。30例(83%)Lachman征及旋转移位试验阴性。Lysholm评分由术前平均(55.7±3.1)分增加至术后最后一次随访时的(90.1±2.7)分(P0.001)。而Tegner评分则由术前平均(5.0±1.4)分增加至术后(6.25±1.2)分(P0.001)。与术前X线检查相比,无退行性改变。结论采用自体骨-1/3髌腱-骨重建前交叉韧带后2年以上随访结果发现,83%的患者膝关节不稳现象消失,至术后最后一次随访时膝关节功能评分较术前显著增加。以该方法重建ACL有效地恢复了受伤膝关节功能。

Effect of arthroscopic reconstruction of anterior cruciate ligament using autogenous patellar tendon

Objective To investigate the effect of reconstruction of anterior cruciate ligament（ACL） by bone-patellar tendon-bone（B-PT-B）.Methods Forty cases of isolated anterior cruciate ligament rupture associated with symptomatic anterior tibial subluxation were reconstructed using bone-one-third patella tendon-bone autograft.A 6-month rehabilitation program was taken out post-operatively.Physical findings and functional scores were recorded prior to operation and at follow-up examinations,and knee radiographs were analyzed as well.Results Thirty-six patients（90%） were available for follow-up at a mean of thirty-one months.Thirty of the patients（83%） had negative Lachman and pivot shift.The mean Lysholm and Tegner scores improved from 55.7±3.1 and 5.0±1.4 points pre-operatively to 90.1±2.7 and 6.25±1.2 points at the time of follow-up respectively（P0.001）.No evidence of progressive degenerative change presented on the follow-up radiographs.Conclusion ACL reconstruction using bone-one-third patella tendon-bone autograft eliminates the tibial subluxation effectively in 83% patients at a minimum follow-up period of 2 years.Post-operative functional scores of the knees increase significantly at the latest follow-up.The function of the injured knees is restored effectively by such a reconstruction.