关节镜下采用6～8股腘绳肌腱单束重建前交叉韧带

目的:探讨关节镜下采用6-8股腘绳肌肌腱单束重建前交叉韧带对恢复膝关节稳定性的临床效果。方法:前交叉韧带损伤患者14例,男9例,女5例;年龄19-51岁,平均32.8岁;病程1-22个月,平均3.7个月。Lachman试验:阳性伴软性终止点12例,阳性伴硬性终止点2例;前抽屉试验:阳性伴软性终止点12例,阳性伴硬性终止点2例;轴移试验阳性12例。合并I度膝关节外翻不稳1例。在关节镜下采用6-8股腘绳肌肌腱单束重建,4孔指骨钢板对移植物行悬吊式固定。结果:术后1年随访,13例患者Lachman试验阴性,1例患者Lachman试验阳性,13例患者轴移试验阴性,1例患者阳性。按照Lysholm膝关节评分标准,评分从术前平均(47.71±1.98)分提高至术后平均(95.36±4.73)分,差异有显著性意义(P<0.01)。结论:关节镜下采用6-8股腘绳肌肌腱单束重建前交叉韧带是恢复膝关节稳定性的可靠方法,具有切口小,对伸膝装置无干扰等优点。     

关节镜下保留残存纤维结合七股自体腘绳肌腱单束重建后交叉韧带

目的研究膝关节镜下保留残存后交叉韧带(PCL)纤维结合7股自体腘绳肌腱单束重建PCL的临床效果。方法对13例PCL损伤,采用胫骨隧道技术结合7股自体腘绳肌腱进行单束重建,术中保留残存PCL纤维,移植物使用悬吊式固定,手术前后采用Lysholm膝关节功能评价表和Tegner下肢运动能力评价表进行评估,并了解患者膝关节的稳定性、活动度。结果所有患者随访12～36个月,术前和术后12个月Lysholm评分分别为(50.20±8.32)分和(87.23±4.20)分(P<0.05),Tegner评分分别为(2.03±0.33)分和(4.11±0.13)分(P<0.05)。术后12个月后抽屉试验阴性7例,Ⅰ度阳性5例,Ⅱ度阳性1例,所有患膝运动能力均较术前有所改善。结论关节镜下采用经胫骨隧道技术保留残存纤维结合7股自体腘绳肌腱单束重建PCL是一种恢复膝关节稳定性和功能的可靠方法。     

自体腘绳肌肌腱重建前交叉韧带的研究进展

前交叉韧带（ACL）损伤是膝关节的常见损伤。手术重建已成为治疗ACL损伤后膝关节不稳的首选方法。与传统的髌韧带重建方法相比，采用腘绳肌肌腱（HT）重建具有取材部位病损少、膝前疼痛和跪地疼痛发生率低等优点。本文就HT重建ACL的基础和临床研究进行综述。     

关节镜下实施自体腘绳肌腱重建前交叉韧带的效果分析

目的分析关节镜下实施自体腘绳肌腱重建前交叉韧带的效果。方法对40例膝关节前交叉韧带损伤患者实施关节镜下自体腘绳肌腱重建治疗,并对其临床效果进行回顾性分析。结果患者均顺利完成手术,未发生感染、韧带再断裂、挤压钉脱落等并发症。患者均获12~24个月随访。末次随访Lachman征和旋转移位试验均为阴性,X线检查无退行性改变,Lysholm评分及Tegner功能评分均优于术前,差异均有统计学意义(P0.05)。结论对前交叉韧带损伤患者实施自体腘绳肌腱重建前交叉韧带治疗,创伤小、术后并发症少、膝关节功能恢复好。     

关节镜下无植入物固定自体腘绳肌腱双束重建前交叉韧带

目的 总结关节镜下使用自体腘绳肌腱胫骨双隧道双束无植入物固定重建膝前交叉韧带(anterior oruciate ligament,ACL)的近期临床效果. 方法 2004年3月-2007年6月,收治12例ACL损伤患者,男8例,女4例:年龄23～56岁,平均32岁.车祸伤9例,运动伤3例.术前前抽屉试验(anterior drawer test,ADT):2度2例,3度10例:Lachrnan试验均为3度;轴移试验:1度2例,2度6例,3度4例.国际膝关节评分委员会(international knee doeumentation committee,IKDC)评分为(39.3±4.7)分,Lysholm评分为(44.4 ±4.9)分.均在关节镜下采用自体腘绳肌腱双束无植入物固定重建ACL. 结果 患者切口I期愈合,无术后并发症发生.术后患者均获随访,随访时间10～22个月,平均15个月.术后12周ADT试验1度9例,2度3例;Lachman试验1度8例,2度3例,3度1例;轴移试验:0度9例,1度3例.IKDC评分为(92.4±3.7)分,Lysholm评分为(91.6±2.7)分,均优于术前(P<0.01). 结论 关节 镜下应用自体腘绳肌腱胫骨双隧道双束无植入物固定,重建ACL符合其解剖重建和生理学功能,近期疗效好.     

关节镜下自体腘绳肌腱与腓骨长肌腱单束重建前交叉韧带

[目的]比较关节镜下应用自体腘绳肌与自体腓骨肌腱单束重建前交叉韧带(ACL)的临床疗效。[方法]回顾性分析2014年7月~2017年12月在本院行关节镜下单束重建ACL的46例患者,26例采用自体腘绳肌腱,20例采用自体腓骨长肌腱。采用国际膝关节评分委员会(IKDC)及Lysholm评分对膝关节功能进行评估,并应用FADI评分对患肢踝关节功能进行评估,并记录患肢大腿周径的变化。应用膝关节MRI对移植物连续性进行评估。[结果]两组患者均顺利完成手术。两组患者手术时间、术后恢复下地行走时间等差异无统计学意义(P0.05)。术中取腱初始长度、腱编织后移植物直径自体腓骨长肌腱组明显大于自体腘绳肌腱组,但自体腓骨长肌腱组手术切口总长度显著长于腘绳肌腱组,差异有统计学意义(P0.05)。两组患者随访12~18个月,平均(14.93±1.97)个月。术后1年时两组患者的IKDC、Lysholm评分均较术前显著增加(P0.05),但相应时间点两组间差异均无统计学意义(P0.05)。术后1年时两组患肢踝关节功能FADI评分差异无统计学意义(P0.05),自体腓骨长肌移植组术后1年时大腿周径双侧差值明显小于腘绳肌腱组(P0.05)。术后1年时MRI评估,腘绳肌腱组移植物连续性显示良好23例,中等3例;腓骨肌腱组显示良好18例,中等2例,两组的差异无统计学意义(P0.05)。两组患者均未见髁间撞击征发生。[结论]自体腓骨长肌单束重建前交叉韧带术后1年时可达到与自体腘绳肌腱移植类似的膝关节功能学评分,该方法术中可获得具有更大直径的移植物,术后患肢大腿肌肉萎缩程度较轻,且对踝关节功能无明显影响。     

关节镜下髌韧带和六股异体腘绳肌腱单束重建前交叉韧带的临床研究

目的 比较关节镜下采用髌韧带和六股异体腘绳肌腱单束重建前交叉韧带的临床效果.方法 回顾性分析2006年10月至2009年12月我科采用关节镜下异体移植物单束重建前交叉韧带(ACL)的108例患者的临床资料,其中六股异体腘绳肌腱58例(腘绳肌腱组),异体髌韧带50例(髌韧带组).术后应用Lachman和pivot-shift试验以及KT-1000评估膝关节稳定性,按照国际膝关节评分委员会(IKDC)、Lysholm膝关节评分评价膝关节功能.结果 术后患者随访时间12～38个月,平均为28.6个月.腘绳肌腱组KT-1000检查示双侧膝关节前向松弛度差异为(1.2±1.2)mm,显著小于髌韧带组(1.8±1.5)mm,差异具有统计学意义(P＜0.05).腘绳肌腱组轴移试验阴性55例(94.8%),阳性3例(5.2%),髌韧带组阴性41例(82.0%),阳性9例(18.0%),差异具有统计学意义(P＜0.05).术后腘绳肌腱组和髌韧带组IKDC评分为(90±5)分和(89±5)分,Lysholm评分为(94±5)分和(93±6)分,两组比较差异无统计学意义(P＞0.05).结论 关节镜下单束重建前交叉韧带采用六股异体腘绳肌腱较髌韧带能够明显提高膝关节稳定性.

Abstract：

Objective To compare the outcome of arthroscopic single-bundle anterior cruciate ligament(ACL)reconstruction with six-strand hamstring tendon and patellar tendon allograft.Methods From October 2006 to December 2009,108 patients with arthroscopic single-bundle ACL reconstruction were retrospectively reviewed,with 58 patients with six-strand hamstring tendon(Group H),and 50 patients with patellar tendon allograft(Group P).Patients were available for clinical evaluation with KT-1000 arthrometer measurements,Lachman and pivot-shift test,and knee function with the Internationa]Knee Documentation Committee(IKDC),Lysholm scores.Results All the patients were followed up at an average of 28.6 months(range 12-38 months).The average side-to-side difference was lesser for group H(1.2 ± 1.2)mm than group P(1.8 ±1.5)mm(P＜0.05).On the pivot-shift test,55(94.8%)patients were negative and 3(5.2%)were positive in group H,whereas 41(82.0%)were negative and 9(18.0%)were positive in group P,with significant difference between two groups(P＜0.05).All knee function scores were improved postoperatively,without statistically significant difference between the two groups(P＞0.05).Conclusion Arthroscopic single-bundle ACL reconstruction with six-strand hamstring tendon will achieve better knee stability than patellar tendon allograft.     

关节镜下四股腘绳肌腱重建后交叉韧带

目的 探讨关节镜下四股腘绳肌腱重建后交叉韧带及其影响因素。方法 采用开口螺旋肌腱剥离器，保留肌腱远端附着点，肌腱肌肉交界处切断肌腱，对折四股编织转移镜下重腱后交叉韧带，内口侧采用可吸收挤压螺钉固定。结果 12例术后平均随访29个月。术前后抽屉试验10例阳性，术后1例阳性；Lachman试验术前均阳性，术后1例阳性，1例弱阳性；轴移试验术前5例阳性，术后均消失。按照日本骨科协会制定的膝关节疗效评定标准，优良率为83．3％。结论 镜下四股腘绳肌腱重建后交叉韧带，韧带两端无骨块，通过隧道较B-PT-B顺畅。可吸收螺钉在隧道内口侧固定，愈后内口消失，避免受韧带撞击使之逐渐扩大引起重建韧带松驰、关节不稳。胫骨隧道外口原附着点的牢固附着，股骨隧道外口的坚强固定，使重建后交叉韧带有足够强度。手术具有创伤小，能早期锻炼，功能恢复快的特点。     

关节镜下采用腘绳肌肌腱指骨钢板悬吊固定重建前交叉韧带

[目的]探讨关节镜下采用腘绳肌肌腱指骨钢板悬吊固定法重建前交叉韧带(ACL)的临床效果。[方法]对13例前交叉韧带断裂的患者,在关节镜下采用6~8股腘绳肌肌腱进行单束双隧道重建,4孔指骨钢板对移植物行悬吊式固定。术后1 a随访,并按照Lysholm膝关节评分标准评价疗效。[结果]12例患者(92.31%)Lachm an试验阴性,1例患者Lachm an试验阳性,12例患者轴移试验阴性,1例患者阳性。按照Lysholm膝关节评分标准,评分从47.77±1.96提高至95.38±4.74,差异有显著性意义(P<0.01)。[结论]关节镜下采用腘绳肌肌腱指骨钢板悬吊固定重建前交叉韧带是恢复膝关节稳定性的可靠方法。     

关节镜下应用RIGIDfix和Intrafix系统固定自体4股腘绳肌重建前交叉韧带

[目的]探讨关节镜下应用RIGIDfix和Intrafix系统固定自体4股腘绳肌重建前交叉韧带的临床效果。[方法]对36例前交叉韧带断裂的患者,在关节镜下采用4股腘绳肌肌腱行前交叉韧带重建,应用RIGIDfix和Intrafix系统对移植物进行固定,术后进行系统的康复治疗并处理相关的并发症。术后随访6～12个月,询问患者的主观症状,并对患者进行膝关节活动度、前抽屉试验、Lachman试验和轴移试验等检查,按照Lysholm膝关节评分标准评价疗效。[结果]本组病例均未发生严重并发症,术后进行6～12个月的随访,所有患者均已返回工作岗位,膝关节屈曲均达到130°,伸直达到0°,有3例在激烈活动时有时会感觉到膝关节打软不稳,其余病例均无打软不稳的感觉。随访时前抽屉试验35例阴性,1例阳性;Lachman试验33例阴性,3例阳性;轴移试验均为阴性。按照Lysholm膝关节评分标准,评分从51.3±4.2分提高至85.6±4.6分,差异有显著性意义(P<0.01)。[结论]关节镜下应用RIGIDfix和Intrafix系统固定自体4股腘绳肌肌腱重建前交叉韧带是治疗前交叉韧带损伤的一种较好方法,具有手术操作简单、固定牢固、愈合率高等优点。     

关节镜下四股腘绳肌腱重建后交叉韧带

目的 探讨关节镜下四股腘绳肌腱重建后交叉韧带及其影响因素。方法 采用开口螺旋肌腱剥离器,保留肌腱远端附着点,肌腱肌肉交界处切断肌腱,对折四股编织转移镜下重腱后交叉韧带,内口侧采用可吸收挤压螺钉固定。结果 12例术后平均随访29个月。术前后抽屉试验10例阳性,术后1例阳性;Lachman试验术前均阳性,术后1例阳性,1例弱阳性;轴移试验术前5例阳性,术后均消失。按照日本骨科协会制定的膝关节疗效评定标准,优良率为83.3％。结论 镜下四股(?)绳肌腱重建后交叉韧带,韧带两端无骨块,通过隧道较B—PT—B顺畅。可吸收螺钉在隧道内口侧固定,愈后内口消失,避免受韧带撞击使之逐渐扩大引起重建韧带松驰、关节不稳。胫骨隧道外口原附着点的牢固附着,股骨隧道外口的坚强固定,使重建后交叉韧带有足够强度。手术具有创伤小,能早期锻炼,功能恢复快的特点。     

Anterior Cruciate Ligament Double-Bundle Reconstruction With Hamstring Tendon Autografts

The anterior cruciate ligament (ACL) surgical technique via a 5-strand hamstring tendon autograft is designed with a conventional single-bundle reconstruction that has shown favorable results and an additional posterolateral (PL) bundle reconstruction. The conventional single-tunnel technique is performed for the tibial tunnel, and the double-tunnel technique is performed for the femoral tunnel. The anteromedial (AM) femoral tunnel is prepared with 1 mm of the posterior femoral cortex being left over the top at the 11- to 1-o’clock position. The PL femoral tunnel is prepared with the outside-in technique by use of a 4.5-mm cannulated reamer. The AM bundle is fixed with a rigid fixation system on the femoral side, and the PL bundle is fixed to tie with the miniplate from the outside femur. A double-bundle reconstruction with 5-strand hamstring autografts, in conjunction with a conventional AM bundle and an additional PL bundle, seems to be a very effective method for the treatment of ACL instabilities. Although the long-term clinical outcome of the procedure is yet to be determined, complications including graft impingement, limitation in range of motion, and residual instability have not been observed to date in the first 38 patients who have undergone our technique.     

关节镜下自体髌腱重建前交叉韧带及有关问题的探讨

目的 报告关节镜下自体髌腱中１／３重建前交叉韧带（ＡＣＬ）,并分析影响手术效果的因素。方法 采用关节镜下自体骨－髌腱－骨（Ｂ－ＰＴ－Ｂ）中１／３重建ＡＣＬ。手术１５例,男１０例,女５例,年龄２１～４０岁,平均２６岁,术后随访５－１９个月,平均随访１３个月,术前抽屉试验１５例均阳性,术后２例阳性,轴移试验３例阳性,术后均消失,Ｌａｃｈｍａｎ试验有５例阳性,术后２例弱阳性,膝前疼痛３例,结果 按照日本     

关节镜下自体四股腘绳肌腱可吸收界面螺钉重建前交叉韧带

目的探讨自体四股绳肌腱、可吸收界面螺钉重建前交叉韧带(anteriorcruciateligament,ACL)的手术方法及疗效。方法关节镜下以自体四股绳肌腱为ACL重建替代物,保留少许ACL残端作为定位标志物,应用可吸收界面螺钉固定,对37例ACL损伤病例行重建术。结果随访6～28个月,平均11.4个月。术后36例膝关节活动度在正常范围,无韧带撞击现象。Lachman试验:33例≤1 ,4例2 。轴移试验术后全部阴性。Lysholm评分由术前的平均50.1分提高到术后的平均90.5分,差异有显著性意义(P<0.05)。结论关节镜下自体四股绳肌腱、可吸收界面螺钉重建ACL是恢复膝关节稳定性较好的方法。准确的关节内入口定位是手术成功的关键。     

关节镜下应用钮扣式钢板固定四股自体股腘绳肌腱重建前交叉韧带

目的 探讨关节镜下应用钮扣式钢板固定四股自体腘绳肌腱重建膝关节前交叉韧带（anterior cruciate ligament,ACL）的临床疗效. 方法 对32例前交叉韧带损伤者在关节镜下应用钮扣式钢板固定四股腘绳肌腱重建术.术前和术后进行Lachman试验、轴移试验评估膝关节的稳定性,用Lysholm评分法评价膝关节功能.术前常规行MRI及膝关节正侧位、髌骨轴位X线片检查,排除前交叉韧带起止点骨性撕脱. 结果 32例随访3.5～29个月,其中25例＞12个月.所有病例膝关节不稳定感明显改善.术前Lachman试验阳性32例,轴移试验阳性28例.Lysholm综合评分51.8±5.6.术后Lachman试验30例阴性,2例弱阳性,轴移试验均为阴性,膝关节功能Lysholm综合评分为90.7±2.5.3例关节积液,经关节穿刺抽吸后吸收. 结论 关节镜下应用钮扣式钢板固定四股自体腘绳肌腱重建膝ACL的近期临床疗效良好.     

改良关节镜下前交叉韧带重建术的安全性研究

目的探讨关节镜下经前内侧入路（anteromedial,AM）建立股骨隧道的膝关节前交叉韧带（anterior cruciateligament,ACL）移植重建手术的改良方法的安全性。方法 2010年1～10月采用改良AM方法完成ACL重建20例（实验组）,2009年1～12月采用传统AM方法完成ACL重建20例（对照组）,比较2组股骨隧道的长度,股骨隧道斜度,股骨外髁后壁爆裂和后外侧管神经损伤的情况。结果实验组术中股骨隧道长度为（41.8±4.1）mm,显著长于对照组（37.2±4.4）mm（t=3.421,P=0.002）。实验组股骨隧道冠状角度为51.9°±7.7°,显著大于对照组39.1°±5.8°（t=5.938,P=0.000）。对照组1例出现股骨隧道后壁爆裂,2组其余患者未发现后壁爆裂和后外侧血管神经损伤。结论改良AM方法可以增加ACL重建手术的安全性。     

Anatomic Anterior Cruciate Ligament Reconstruction

Anterior cruciate ligament reconstruction (ACLR) techniques have substantially evolved over the past several decades, driven by evidence that nonanatomic techniques increase the risk for instability, loss of motion, surgical failure, and posttraumatic osteoarthritis. Early techniques used transtibial femoral tunnel drilling, although improved understanding of the anatomy and biomechanics has led to independent femoral tunnel. Anatomic ACLR requires careful consideration of the native ACL dimensions and orientation. Although there is significant variation between patients, understanding of anatomic patterns allows for reliable identification of the ACL footprints and appropriate tunnel positioning, particularly in chronic injuries where the remanent ACL stump is degraded or absent. The femoral tunnel should be placed low and posterior on the lateral femoral condyle using the lateral intercondylar and bifurcate ridges as landmarks. The center of the tibial footprint can be determined by referencing the medial tibial spine and posterior border of anterior horn of lateral meniscus. Measurement of the dimensions of the native ACL and intercondylar notch is also critical for determining graft size and minimizing the risk of impingement, with a goal of reconstructing 50% to 80% of the tibial footprint area. Clinical outcome studies have demonstrated superior anteroposterior and rotatory knee stability with low surgical revision rates (reported between 3% and 5%). By adhering to the principles of anatomic ACLR, surgeons can produce an appropriately sized and located graft for the individual patient, thereby best restoring native knee kinematics and maximizing function. The aim of this infographic is to highlight essential features of anatomic ACLR techniques, which a focus on the native anatomy and surgical planning to achieve an anatomic ACLR.     

Arthroscopic Double-Bundle Anterior Cruciate Ligament Reconstruction: An Anatomic Approach

The anterior cruciate ligament consists of 2 functional bundles, the anteromedial and the posterolateral bundle. Anterior cruciate ligament reconstruction has traditionally focused on recreating the anteromedial bundle, while the reconstruction of the posteromedial bundle has not routinely been addressed. The authors, from 2 academic centers, present a technique of arthroscopic anterior cruciate ligament reconstruction that restores both the anteromedial and the posterolateral bundle using either semitendinosus and gracilis autografts or tibialis anterior allografts. This technique represents a novel approach to restore the anteromedial and the posterolateral bundle at their anatomic insertion sites on both the tibia and the femur through separate bone tunnels. We believe that our double-bundle anatomic anterior cruciate ligament reconstruction closely reapproximates the native insertion sites of the anterior cruciate ligament on the tibia and the femur while more closely recreating the biomechanical function of the native ligament.