关节镜下双股半腱肌腱转移重建后交叉韧带

目的:报告关节镜下双股半腱肌腱转移重建后交叉韧带及分析影响其手术效果因素.方法:采用开口螺旋肌腱剥离器,保留肌腱远侧附着点,在近侧腱肌交界处切断半腱肌腱,对折两股编织转移镜下重建后交叉韧带.隧道内口侧可吸收挤压螺钉固定,股骨隧道外口加强固定.结果:手术28例,平均随访33个月,按照日本骨科协会制定的膝关节疗效评定标准,优良率为85.7%.结论:(1)关节镜下双股半腱肌腱转移重建后交叉韧带,较B-PT-B通过隧道时柔顺通畅;(2)隧道内口可吸收钉挤压固定,愈后内口消失,避免韧带撞击内口使之逐渐扩大引起重建韧带松驰.(3)隧道内外口的坚强固定,使重建后交叉韧带有足够刚强度.     

关节镜下双股半腱肌腱转移重建后交叉韧带

目的：报告关节镜下双股半腱肌腱转移重建后交叉韧带及分析影响其手术效果因素。方法：采用开口螺旋肌腱剥离器，保留肌腱远侧附着点，在近侧腱肌交界处切断半腱肌腱，对折两股编织转移镜下重建后交叉韧带。隧道内口侧可吸收挤压螺钉固定，股骨隧道外口加强固定。结果：手术28例，平均随访33个月，按照日本骨科协会制定的膝关节疗效评定标准，优良率为85．7％。结论：(1)关节镜下双股半腱肌腱转移重建后交叉韧带，较B-PT-B通过隧道时柔顺通畅；(2)隧道内口可吸收钉挤压固定，愈后内口消失，避免韧带撞击内口使之逐渐扩大引起重建韧带松驰。(3)隧道内外口的坚强固定，使重建后交叉韧带有足够刚强度。     

关节镜下双股半腱肌腱重建后十字韧带及相关问题的探讨

目的 观察关节镜下双股半腱肌腱转移重建后十字韧带(posterior cruciate ligament,PCL）的效果，分析其影响因素。方法 1998年6月～2002年6月共收治28例PCL损伤患者，男22例，女6例；年龄18～31岁，平均22.5岁。使用开口螺旋肌腱剥离器剥离半腱肌腱，保留肌腱远端附着点，在靠近肌腱肌腹交界处切断，对折成两股，关节镜下重建PCL，内口侧使用可吸收挤压螺钉固定。结果 术后平均随访33个月。后抽屉试验术前26例阳性，术后2例；Lachman试验术前均阳性，术后3例阳性，2例弱阳性；轴移试验术前12例阳性，术后均消失。随访评分采用IKDC评分方法：A级9例（32.1%)，B级16例（57.1%)，C级3例（10.8%)；Lysholm膝关节功能评分为92.7分。结论 关节镜下使用双股半腱肌腱转移重建PCL，通过两隧道转折处时，由于韧带两端无骨块，操作容易。可吸收挤压螺钉在隧道内口侧挤压固定，愈合后内口消失，避免隧道内口扩大导致韧带松弛、关节不稳。胫骨隧道外口原附着点附着牢固，股骨隧道外口固定坚强，重建韧带强度大。该手术还具有创伤小，能早期功能锻炼，并发症少等优点。     

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。     

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。     

关节镜下双隧道半腱肌腱重建后交叉韧带

目的 :探讨关节镜下应用双股折叠半腱肌腱重建后交叉韧带 (Posteriorcruciateligament)的方法及疗效。方法 :2 0 0 0年 8月～ 2 0 0 3年 7月共收治 19例PCL损伤患者 ,使用开口螺旋肌腱剥离器剥离半腱肌腱 ,在肌腱肌腹交接处切断 ,保留肌腱远端附着点 ,纵切为两股 ,对折缝合。于股骨内髁PCL附着点处分别钻取前后两隧道 ,与胫后内外两隧道引出的重建韧带形成交叉 ,游离端使用可吸收螺钉固定。结果 :术后平均随访 16.3个月 ,Lachman试验术前 19例阳性 ,术后 1例阳性。轴移试验术前 10例阳性 ,术后均消失 ,Lysholm膝关节功能评分平均 93 .6分。IKDC评分 :A级 10例 ,B级 8例 ,C级 1例。结论 :关节镜下使用双隧道双股折叠半腱肌重建PCL能进一步恢复原有的解剖学特点 ,具有操作简单 ,重建韧带强度大 ,稳定性强 ,并发症少 ,能早期活动等优点。     

关节镜下应用Endopearl与Intrafix固定四股半腱肌腱重建膝关节后交叉韧带

目的探讨关节镜下应用Endopearl与Intrafix固定四股半腱肌腱重建膝关节后交叉韧带的近期临床效果。方法取自体的双侧半腱肌腱对折成四束后对12例单纯后交叉韧带损伤(新鲜损伤5例,陈旧性损伤7例;Ⅱ度损伤4例,Ⅲ度损伤8例)行关节镜下重建,移植肌腱股骨侧用Endopearl加可吸收界面螺钉固定,胫骨侧用Intrafix固定。结果12例均获得随访,随访时间7~14个月(平均8.5个月);术后3个月膝关节活动范围均超过120°,无伸膝受限,后抽屉试验Ⅰ度阳性2例,其余为阴性;Lyshlom评分从术前(85.55±2.68)分增加至术后(90.6±2.3)分。结论关节镜下应用Endopearl与Intrafix固定四股半腱肌腱单束重建膝关节后交叉韧带方法确切,可有效恢复膝关节功能。     

关节镜下四股半腱肌股薄肌肌腱重建交叉韧带

目的 探讨关节镜下采用可吸收界面螺钉固定四股半腱肌股薄肌肌腱重建交叉韧带的临床疗效.方法 关节镜下采用四股自体半腱肌股薄肌肌腱移植加可吸收螺钉固定法治疗6例交叉韧带损伤患者.结果 6例患者随访10个月,按Lysholm膝关节功能评分标准,术前膝关节功能评分平均为56.7分,术后10个月时为76～96分(平均82.2分).结论 自体四股半腱肌股薄肌肌腱弹性模量与交叉韧带相似,强度大于交叉韧带.植入物为四股,可吸收螺钉固定,固定牢固,生物相容性好.     

关节镜下双股半腱肌腱单端固定法重建膝交叉韧带

目的观察膝关节镜下双股半腱肌腱单端固定法重建膝前、后交叉韧带的方法及疗效,探讨其优缺点。方法应用双股半腱肌腱,单端固定,重建前交叉韧带损伤38例,后交叉韧带24例。结果所有患者术后随访6～36个月,平均18个月。按Lysholm膝关节评分标准,由术前43分提高到术后93分。结论双股半腱肌腱,单侧固定法重建前、后交叉韧带具有创伤小,操作简便,是重建前、后交叉韧带的理想方法之一。     

关节镜下腘绳肌重建膝前交叉韧带的临床研究

目的探讨关节镜下腘绳肌重建膝关节前交叉韧带的方法,并对其中期临床疗效进行分析。方法自2003年5月～2005年6月,采用自体双股半腱肌腱结合双股股薄肌腱重建膝关节前交叉韧带75例。其中,男64例,女11例;年龄16～60岁,平均年龄27.5岁。左膝32例,右膝43例。取患膝半腱肌、股薄肌肌腱,予修整、编织缝合后植入制备好的骨道内,股骨端移植物行横杆悬挂法固定,胫骨端用生物可吸收界面螺钉加钛门形钉固定。结果62例获得随访,随访时间15～36个月,平均26个月。得到随访的62例中,术前Lysholm评分(46.1±2.6)分,随访时Lysholm评分(92.5±4.2)分。用配对t检验进行统计学分析发现,术前和术后随访时相比有极显著性差异(P<0.01)。结论关节镜下腘绳肌移植重建膝前交叉韧带是一种微创、疗效确切的方法。     

Arthroscopic double-bundled posterior cruciate ligament reconstruction with quadriceps tendon–patellar bone autograft

Summary: An arthroscopic technique for double-bundled reconstruction for posterior cruciate ligament with quadriceps tendon–patellar bone autograft is presented. Anterolateral and posteromedial tunnels were created to simulate and reproduce the double-bundle structure of the posterior cruciate ligament. The bone plug is situated at the tibial tunnel and fixed by a titanium interference screw. Each of the bundles of tendon graft is rigidly fixed at the femoral tunnel with a bioabsorbable screw.Arthroscopy: The Journal of Arthroscopic and Related surgery, Vol 16, No 7 (October), 2000: pp 780–782     

Anatomic double-bundle posterior cruciate ligament reconstruction using hamstring tendons

Recent biomechanical studies have shown that an anatomic double-bundle posterior cruciate ligament (PCL) reconstruction is superior in restoring normal knee laxity compared with the conventional single-bundle isometric reconstruction. We describe a modification of an endoscopic PCL reconstruction technique using a double-bundle Y-shaped hamstring tendon graft. A double- or triple-bundle semitendinosus-gracilis tendon graft is used and directly fixed with soft threaded biodegradable interference screws. In the medial femoral condyle, 2 femoral tunnels are created inside-out through a low anterolateral arthroscopic portal. First, in 80° of flexion, the double-stranded gracilis graft is fixed with an interference screw inside the lower femoral socket, representing the insertion site of the posteromedial bundle. In full extension the combined semitendinosus-gracilis graft is pretensioned and fixed inside the posterior aspect of the single tibial tunnel. The double- or triple-stranded semitendinosus tendon is inserted in the higher femoral tunnel, presenting the insertion site of the anterolateral bundle. Finally, pretension is applied to the semitendinosus bundle in 70° of flexion and a third screw is inserted. Using this technique, the stronger semitendinosus part of the double-bundle graft, which mimics the anterolateral bundle of the PCL, is fixed in flexion, whereas the smaller gracilis tendon part (posteromedial bundle) is fixed in full extension. Thus, a fully arthroscopic anatomic PCL reconstruction technique is available that may better restore normal knee kinematics as compared to the single-stranded isometric reconstruction.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 1 (January), 2001: pp 88–97     

改良全关节镜下胫骨Inlay技术重建后十字韧带的实验研究

目的 探讨采用改良全关节镜下胫骨Inlay技术重建膝关节后十字韧带(posterior cruciate ligament,PCL)手术方法的特点及优势.方法 设计专门的胫骨隧道形态及配套的胫骨钻头,设计移植物的形态和固定方法.在5具成人膝关节标本上模拟操作,年龄25～65岁;左膝2例,右膝3例.设计出全关节镜下胫骨Inlay技术重建PCL的手术操作流程(包括建立胫骨隧道的方法,移植物的引入等).操作完成后切开实验标本,进行二次观察,观察胫骨隧道内口的形态和位置是否达到设计的要求.通过对30张正常MRI片进行测量,确定胫骨隧道的角度,明确术中PCL定位器的角度.结果 胫骨隧道内口设计成14 mm×7 mm×15 mm的圆锥状,外口为直径7 mm的圆柱状,配套的胫骨钻头设计成分体式,钻头在体外装配.胫骨平台后缘斜坡与水平成36°～47°,定位器角度设定为50°.移植物使用异体跟腱,移植物骨块设计成圆锥状,与胫骨隧道内口相匹配,移植物胫骨隧道外口使用纽扣钢板固定.5例标本手术均获得成功,切开行二次检查结果显示,其中4例移植物和胫骨隧道匹配,另1例隧道外口直径偏小,移植物无法完全嵌入.结论 改良全关节镜下胫骨Inlay技术重建膝关节PCL手术具有操作简单、准确、快速、固定牢靠的特点.

Abstract：

Objective To improve the arthroscopic posterior cruciate ligament (PCL) reconstruction using tibial Inlay technique. Methods The special arthroscopic device and related fixation technique were designed. Five cadaveric knees were used to simulate the process of arthroscopic posterior cruciate ligament reconstruction using tibial Inlay technique. The knees were cut open to observe whether the outlet of the tibial tunnel shape and location met the design requirements. Thirty normal MRI films were measured to identify tunnel angle and localizer angle. Results The inner outlet of tunnel was conical shape(14 mm×7 mm×15 mm) and the outer outlet was cylinder-shaped (a diameter of 7 mm). The tibial drill was designed into a split structure and could be assembled in vitro. According to the data obtained from MRI films, the angle between the plane of posterior cruciate ligament and horizontal place was 36°-47°, and the localizer was fixed at 50°.The achilles tendon was used as implant and the allogft bones were designed into conical shape to fit the inner outlet of tunnel. The other end of implant to the proximal tibia was fixed with button plate. All reconstruction operations were performed under arthroscopy. The outcomes of procedure were satisfactory. There were no vascular or peripheral nerve injuries in the cadaveric knees The tunnel position was accurate and the shape of tunnel had met the design requirements. Conclusion Our results imply that improved arthroscopic of posterior cruciate ligament using tibial Inlay technique is simple, accurate, rapid and stable fixation.     

Double-bundle posterior cruciate ligament reconstruction with quadriceps and semitendinosus tendon grafts

This study presents a novel arthroscopic technique for double-bundle reconstruction of the posterior cruciate ligament. A quadriceps tendon-patellar bone autograft is used to reconstruct the major anterolateral bundle. An additional double-stranded semitendinosus tendon is used to reconstruct the posteromedial bundle. In 70° of flexion and full extension with anterior drawer force, the quadriceps tendon graft and semitendinosus tendon graft are fixed inside the anterior aspect of the single tibial tunnel, respectively. An anatomic reconstruction can be achieved by using these 2 autografts.     

Single–Achilles Allograft Posterior Cruciate Ligament and Medial Collateral Ligament Reconstruction: A Technique to Avoid Osseous Tunnel Intersection,Improve Construct Stiffness,and Save on Allograft Utilization

We present a method for single–Achilles allograft medial collateral ligament (MCL) and posterior cruciate ligament (PCL) reconstruction that eliminates the risk of tunnel intersection, stiffens the construct, and maximizes utilization of allograft tissue. An Achilles tendon allograft is prepared with an 11- to 12-mm bone plug with a gradual taper to 7 mm over approximately 15 cm. A transtibial PCL tunnel is created under fluoroscopic and arthroscopic guidance. The femoral tunnel is prepared in an “outside-in” fashion under direct arthroscopic visualization, originating at the anatomic origin of the MCL on the medial epicondyle and entering the joint at the anatomic origin of the anterolateral bundle of the PCL. The Achilles graft is pulled into the joint through the tibial tunnel and routed into the femoral tunnel so that the soft tissue exits at the medial epicondyle. The bone plug is fluoroscopically guided to the posterior aperture of the tibial tunnel and fixed with a bioabsorbable interference screw. The pretensioned graft is fixed in the femoral tunnel via interference screw fixation with the knee in 90° of flexion. The isometric position of the MCL insertion is identified with a K-wire isometer, and the graft is fixed in place at this point by use of an interference screw or screw and washer.     

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。     

Arthroscopic Posterior Cruciate Ligament Augmentation Using an Autogenous Hamstring Tendon Graft and the Posterior-Posterior Triangulation Technique

We describe a modification of the currently practiced arthroscopic posterior cruciate ligament (PCL) reconstruction techniques. We augmented the injured PCL with quadrupled autogenous hamstring tendon grafts using the arthroscopic posterior-posterior triangulation method and a single-incision transtibial approach. The tibial drill guide was introduced through the anteromedial portal and positioned onto the fossa for the PCL on the tibia under arthroscopic guidance from the posterolateral portal. The femoral tunnel was made 10 mm posterior to the articular cartilage of the medial femoral condyle by use of the anterior cruciate ligament Beath pin (Arthrex, Naples, FL) introduced through the far-inferior anterolateral portal. The tendon graft was positioned in the knee joint by use of the tibial and femoral double-folded silk loops that traversed the bony tunnels. The graft was fixed by use of bioabsorbable Intrafix screw systems (DePuy Mitek, Raynham, MA) at both the ends. The arthroscopic posterior-posterior triangulation method provides adequate exposure of the posterior knee compartment; this allows for convenient instrumentation and safe and accurate placement of the bony tunnels with preservation of the PCL remnants. We believe that retention of the remnant PCL fibers is biologic and contributes to earlier healing and strengthening of the tendon graft.     

关节镜下股四头肌腱双束重建后交叉韧带

目的　介绍一种新的后交叉韧带重建手术方法及早期临床疗效。　方法　对 2 0例后交叉韧带损伤病例采用关节镜下前外束及后内束双束重建术。选择一端带骨块的自体股四头肌腱并制备“Y”形双束移植物 ,股骨侧双隧道 ,胫骨侧单隧道。分别在伸膝及屈膝 90°位拉紧固定双束。同时或分次处理复合韧带损伤。　结果　 2 0例均得到随访 ,随访期 6～ 12个月 ,平均 7 5个月。其中单纯后交叉韧带 8例 ,均为Ⅱ°及Ⅲ°损伤。复合损伤 12例。新鲜伤 5例 ,陈旧伤 15例。主观评分示 :Lyshlom评分优者 5例 ( 2 5 %) ,良 14例 ( 70 %) ,差 1例 ( 5 %) ;IKDC评分A级 1例 ( 5 %) ,B级 16例( 80 %) ,C级 2例 ( 10 %) ,D级 1例 ( 5 %)。客观评分 :KT 10 0 0测定 :胫骨后移由术前平均 11 0mm改善至术后 5 5mm。应力X线片测量示胫骨后移由术前平均 11 5mm改善至术后 5 2mm。失效 1例。结论　后交叉韧带双束重建手术是一种有效、可行的重建方法 ,早期临床效果满意。股四头肌腱是后交叉韧带重建的理想移植物。应充分重视复合韧带损伤 ,特别是后外复合体损伤。     

关节镜下月国绳肌腱及生物界面螺钉重建前交叉韧带

目的探讨关节镜下胭绳肌腱及生物界面螺钉重建前交叉韧带的疗效。方法对2007年8月-2009年5月收治的27例前交叉韧带重建病例,采用胭绳肌腱及生物界面螺钉进行重建。男25例,女2例。年龄18±45岁,平均29．6岁。结果22例患者获随访3～24个月,平均8．7月。术后Lysholm评分为91．1±5．3,与术前65．8±5．9比较,差异有统计学意义（P〈0．01）。术后有1例患者发生隐神经损伤,1例出现膝关节化脓性感染,行移植物取出待二期翻修。除感染1例外,其余患者术后患膝活动均正常,不稳感消失。结论胭绳肌腱是修复前交叉韧带的良好移植物,关节镜下界面螺钉固定疗效满意。应避免隐神经损伤和感染等并发症的发生。     

Arthroscopic Reconstruction of the Posterior Cruciate Ligament Using Tibial-Inlay and Double-Bundle Technique

Biomechanical research has suggested that the double-bundle and tibial inlay technique is superior to the single-bundle and the transtibial tunnel method for posterior cruciate ligament (PCL) reconstruction. A combination the posterior tibial inlay and femoral double-bundle technique is thought to be an ideal method for PCL reconstruction. Recently, we successfully performed arthroscopic PCL reconstruction using the tibial-inlay and double-bundle technique. Achilles tendon–bone allograft is used and the bone plug for the arthroscopic tibial inlay fixation is designed in a cylindrical shape and perpendicular to the fiber texture of the Achilles tendon. Achilles tendon is manually split into deep and superficial layers to reconstruct anterolateral and posteromedial bundles as the natural insertion of PCL. The intra-articular lengths of each bundle between tibial tunnel and 2 femoral tunnels are measured to achieve fixation of the graft to the original PCL attachment. After tibial bone plug fixation with an absorbable interference screw and additional suture anchoring, the anterolateral bundle is fixed in a reduction position with the knee in 90° of flexion and the posteromedial bundle is fixed nearly in extension. This procedure makes it possible not only to reproduce the original concept of PCL tibial inlay graft arthroscopically without posterior arthrotomy, but also to achieve a more anatomic PCL reconstruction of the 2 bundles.