异体胫前肌Y型双束双隧道移植重建后交叉韧带的临床研究

目的探讨异体胫前肌Y型双束双隧道重建后交叉韧带（PCL）的临床效果及手术技术改进的方法。方法自2001年3月至2008年1月,采用成人异体胫前肌编制成“Y”型双束,长度为130mm,A端为长束（A束）,B端为两短束（B1、B2束）。韧带安装时两端均从膝前内侧工作通道的切口进入,即：外（膝前内侧工作通道）→内（股骨、胫骨隧道内口）→外（股骨、胫骨隧道外口）。可吸收界面钉先固定胫骨隧道侧,然后再固定股骨侧：固定前外侧束时屈膝90°,固定后内侧束时屈膝30°。术后予膝关节角度锁定助行器辅助锻炼8～10周,3个月后行走基本正常。结果本组47例患者均获得随访,平均随访49．5个月,平均手术时间（45±15）min。Lachmann后向试验术前均阳性,术后38例阴性、5例弱阳性、4例阳性。KT-1000试验术前（9．0±4．0）mm,术后（3．0±1．5）mm,差异有统计学意义（t=3．12,P〈0．01）;Lysholm评分术前（51．4±5．2）分,术后（93．3±4．1）分,差异有统计学意义（t=3．13,P〈0．01）;Tegner活动水平术后（6．9±1．3）分,术前（3．5±0．7）分,差异有统计学意义（t=3．12,P〈0．01）。结论异体胫前肌编制双束有足够的长度和直径重建PCL,其抗拉力强;改进后的韧带过隧道方法,韧带通过隧道时顺畅,简单易操作,省时;准确的隧道内口、正常的张力（角度）固定是效果的保证;动静结合的早期功能锻炼有利于早期功能恢复。

Clinical research on PCL reconstruction by double bundle-double tunnel Y-shape of the anterior tibialis tendon allograft

Objective To investigate the clinical results, improve surgical method and relate issues of PCL reconstruction by double bundle-double tunnel Y-shape of the anterior tibialis tendon allograft. Methods From March 2001 to January 2008, allogeneic adult anterior tibialis tendon was used to prepare ＂Y＂-shape double bundles, the length was 130mm. A bundle was made for A-side, B-side was made for for two short bundles （B1, B2 bundle）. Both ends of the ligament were installed from the antero- medial approach, that means： outside （the antero-medial approach ）-in （femoral and tibial tunnel inside open）-outside （the femoral, tibial outside open）. Absorbable interface screws were firstly fixed in the tibial tunnel, and then fixed in the femoral tunnels ： when being fixed, anterolateral bundle in flexion of 90 degrees, postero-medial bundle in 30 degrees. Assisted exercise with Knee an angle- locked walking aided for 8 - 10 weeks, the normal walking should begin three months later. Results The average operating time was 47 cases were followed-up, with an average follow-up of 49. 5 months ,45 min. Pre-operative Lachman were positive, post-operative 38 cases were negative, weakly positive was in 5 cases and positive in 4 cases. On post-operative KT-1000 testing, Lysholm score and Tegner activity levels were improved significantly compared with that of pre-operative ones. Conclusions Double folded bundles of adult anterior tibialis tendon have sufficient length and diameter for posterior cruciate ligament reconstruction with enough power tension. Improved methods of ligament passing through the tunnel can make ligament pass through the tunnel smoothly, it is easy to use and can save time. Accurate tunnel placement, normal tension and rigid fixation ensured that the results were satisfied. Early dynamic functional exercise is conducive to the early restoration of function.