关节镜下LARS人工韧带重建膝关节后交叉韧带临床效果观察

目的 观察关节镜下LARS人工韧带重建膝关节后交叉韧带的临床效果.方法 选取北部战区总医院2016—2019年收治的因膝关节后交叉韧带损伤行关节镜下LARS人工韧带重建手术的25例患者(25膝)为研究对象.术后随访10～16个月,平均12个月.观察患者的切口愈合和并发症发生情况,比较术前和术后的Tegner评分和Lys...     

关节镜下运用LARS人工韧带Ⅰ期重建同侧膝前、后交叉韧带、膝后外侧结构一例

1病历资料 患者，男性，50岁，2006年8月7日不慎被铲车撞击右膝部。当时右膝部肿胀、疼痛、活动受限。因合并其他部位损伤，当地医院行右下肢石膏固定。2个月后右膝屈伸活动不稳，行走疼痛、乏力。到本院就诊，体检：右膝关节松弛，前后抽屉试验阳性，屈膝90°时小腿外旋角度30°；Artoscan检查提示：右膝前、后交叉韧带断裂（陈旧性），右膝后外侧结构信号紊乱。     

LARS人工韧带与自体腘绳肌腱重建前交叉韧带早期临床疗效比较

目的:前瞻性对照研究LARS人工韧带与四股自体腘绳肌腱(ST/G)重建前交叉韧带(ACL)手术的早期临床疗效。方法:自2004年8月至2005年6月,前瞻性选择了42例前交叉韧带损伤病例,根据LARS人工韧带使用指征、医生建议和患者意愿,分别选择自体腘绳肌腱或LARS人工韧带作为移植物。其中LARS韧带重建ACL病例23例,两端以挤压螺钉固定;四股自体腘绳肌腱重建ACL病例19例,股骨端Endobutton悬吊固定,胫骨端Intrafix挤压螺钉和Spiked-washer拴桩双重固定。均在术前及术后3个月、6个月、9个月和15个月进行Lysholm、TegnerI、KDC评分。结果:采用LARS人工韧带的病例,在术后9个月的随访期内,三种膝关节功能评分值均显著高于自体腘绳肌腱ACL重建的病例(P<0.05)。结论:应用LARS人工韧带重建ACL较使用自体腘绳肌腱重建术后膝关节功能恢复更快。     

关节镜下股骨双隧道“Y”形LARS人工韧带移植重建膝后交叉韧带

目的 探讨在关节镜下应用人工LARS韧带重建膝关节后交叉韧带(PCL)的手术技巧及临床疗效. 方法 选择2006年6月- 2010年8月关节镜下采用LARS人工韧带重建PCL断裂患者14例,其中男10例,女4例;年龄19 ～58岁,平均38岁.致伤原因:运动扭伤9例,交通伤3例,摔伤2例.左侧5例,右侧9例.病程10 d ～1个月,平均15.7d.MRI示:PCL完全撕裂直接征象14例,前交叉韧带(ACL)完全撕裂直接征象2例,合并内侧半月板损伤5例,合并外侧半月板损伤3例,合并髋臼后壁骨折1例.Lysholn膝关节功能评分20～55分[(40 ±7.9)分].按照国际膝关节文件编制委员会( IKDC)评分:C级3例,D级11例.PCL在股骨及胫骨止点、隧道均用定位器完成. 结果 本组所有患者伤口均为Ⅰ/甲愈合,术后无慢性滑膜炎、韧带断裂、韧带松动、活动明显受限等并发症.所有患者均获随访6 ～ 60个月,平均20.5个月.Lysholm膝关节功能评分84 ～93分[(88±3.6)分],与术前比较差异有统计学意义(P＜0.05).术后12个月根据IKDC评分标准分级:A级10例,B级4例. 结论 在关节镜下运用LARS人工韧带重建膝PCL有效恢复了膝关节稳定性,避免了采用自体肌腱重建取材的并发症,也避免了同种异体肌腱移植材料的排斥及传染疾病的并发症.其手术操作简便,创伤小,康复快.     

韧带增强重建系统人工韧带重建前交叉韧带中期疗效分析

目的 评估韧带增强重建系统(ligament advancement reinforcement system,LARS)人工韧带重建前交叉韧带(anterior cruciate ligament,ACL)术后3-7年膝关节功能,了解LARS人工韧带在人体组织内的形态变化. 方法 选择符合标准的LARS人工韧带重建ACL患者57例(58膝),根据伤后至手术时间分为急、慢性损伤两组,对其进行多指标回顾性分析.其中对再手术患者(3例4膝)LARS人工韧带取材行组织学观察. 结果 LARS人工韧带重建ACL术后关节功能、膝关节运动水平明显高于术前(P＜0.01);两组间膝关节功能的主观评分及客观评估差异无统计学意义(P＞0.05);X线片及MRI显示平均1.5年骨隧道呈不同程度进行性扩大,关节稳定性与骨隧道扩大程度无明显相关性(P＞0.05),胫骨和股骨骨隧道扩大发生率差异无统计学意义(P＞0.05).组织学观察可见术后2年有规则排列纤维组织长入LARS人工韧带内,单束及成捆聚酯纤维间见广泛纤维连接. 结论 (1)LARS人工韧带重建ACL能够较好地恢复膝关节稳定性及功能.(2)骨隧道扩大现象存在,1.5年后趋于稳定,关节稳定性与术后骨隧道扩大程度无相关性.(3)急性损伤与慢性损伤术后的各项评估资料对比一致.(4)人体正常纤维组织结构能够规律地长入LARS人工材料.     

术中X线透视定位行LARS韧带重建前交叉韧带的临床价值

目的 探讨在LARS韧带重建前交叉韧带(ACL)手术中,关节镜下运用X线透视定位法的操作特点和临床疗效.方法 2006年6月起运用法国LARS韧带治疗急性膝关节ACL断裂36例,男25例,女11例;年龄22～51岁,平均28.3岁.左膝19例,右膝17例.所有患者术前MRI均提示ACL连续信号中断,膝关节Lysholm评分平均52分.操作在关节镜下完成,其中股骨隧道口定位、胫骨隧道口定位主要依靠术中C形臂X线机定位;LARS韧带直径为7.5 mm,空心挤压螺钉直径为8.0 mm.结果 本组患者获9～20个月(平均18个月)随访.36例患者术前Lysholm评分平均为52分;术后12个月平均为92分.本组优23例,良9例,可4例,近期优良率为89%.结论 在关节镜下运用X线透视定位法进行LARS人工韧带重建膝ACL,操作方便,定位准确,手术效果优良.

Abstract：

Objective To discuss the operation skills and clinical effects of C-arm fluoroscopy in arthroscopic reconstruction of anterior cruciate ligament(ACL)with the Ligament Advancement Reinforcement System(LARS)artificial ligaments.Methods The study involved 36 patients with acute ACL rupture treated with the LARS artificial ligaments from June 2006.There were 25 males and 11 females,at age range of 22-51 years(average 28.3 years),involving 19 left knees and 17 right knees.The results of preoperative MRI of all patients suggested discontinuation of ACL,with average score of Lysholm on knee joint for 50.The operation was completed under arthroscope.While the locations of the femoral tunnel portal and the tibial tunnel exit were mainly determined by the C-arm fluoroscopy.The diameter of the LARS artificial ligament was 7.5 mm while that of the interference screw 8 mm.Results All 36 patients were followed up for a mean duration of 18 months(9-20 months).The average Lysholm Score was 52 preoperatively and 92 at the 12th week after operation.The clinical results were graded as excellent in 23 patients,good in nine and fair in four according to the Lysholm's classification,with excellence rate of 89%.Conclusions Arthroscopic reconstruction of anterior cruciate ligament with LARS artifical ligament under C-arm fluoroscopy takes advantages of convenient operation,accurate location and satisfactory clinical effect.     

军队人员关节镜下重建前交叉韧带

目的 探讨军人前交叉韧带损伤患者采用自体四股半腱肌腱 股薄肌腱重建前交叉韧带的手术方法及远期疗效.方法 关节镜下以自体四股半腱肌腱 股薄肌腱为前交叉韧带重建替代物,保留少许前交叉韧带残端作为定位标志物,对35例前交叉韧带损伤军人行重建术.结果 术后35例膝关节活动度均恢复至正常范围,无韧带撞击现象,前抽屉试验全部阴性,Lachman试验全部小于Ⅰ度.Lysholm评分由术前的平均52.3分提高到术后的平均88.5分,差异有显著性意义(P＜0.01).大多数患者获得满意治疗效果,可继续从事日常工作.结论 关节镜下自体四股半腱肌腱 股薄肌腱重建前交叉韧带是恢复膝关节稳定性较好的方法.关节镜下重建前交叉韧带是前交叉韧带损伤军人较为理想的手术方式,其创伤较小、卧床时间短、远期疗效较好.     

关节镜下保留残迹的后交叉韧带重建

目的 评估关节镜下保留残迹的膝后交叉韧带(PCL)单束重建的技术和效果.方法 自2004年4月至2006年6月,38例(38膝)患者经临床和关节镜检查证实为PCL功能不全,其中9膝伴后外侧角损伤,6膝伴后内侧角损伤,8膝伴外侧半月板破裂,4膝伴内侧半月板损伤.均于关节镜下行保留残迹和滑膜的PCL单束重建术,采用生物可吸收挤压螺钉解剖位复合固定莺建韧带.结果 本组术后早期均未发生严重并发症.术后随访12-37个月[(20.79±7.92)个月],Lysholm膝关节功能评分由术前40～70分[(51.32±9.84)分],提高至随访时70-100分[(92.37±6.95)分](t=-30.14,P<0.01).国际膝关节文件编制委员会(IKDC)标准由术前异常(C级)16例、显著异常(D级)22例,改进为随访时正常(A级)18例、接近正常(B级)18例、异常(C级)2例(Z=-6.00,P<0.01).38例患者中,36例恢复伤前运动水平,2例运动水平较伤前减低.结论 关节镜下保留残迹的PCL单束重建技术可行,治疗效果满意.保留PCL残迹与滑膜可能有利于重建韧带植入物牛物愈合和神经再支配.     

关节镜下双股半腱肌重建前交叉韧带

前交叉韧带（ＡＣＬ）损伤是常见膝部损伤，有关诊断、关节镜下修复重建的问题已引起临床界的重视〔１、２〕。采用我科自行研制的配套器械行双股半腱肌关节镜下重建ＡＣＬ手术，临床治疗５０例前交叉韧带损伤患者，随访资料完整３９例，取得满意的临床效果。１资料与方法...     

三种移植物关节镜下重建前交叉韧带的临床疗效比较

目的比较分析膝关节镜下自体骨-髌腱-骨（B-PT-B）、同种异体跟腱和LARS（1igament advanced reinforce．mentsystem,LARS）人工韧带重建前交叉韧带（anterior cruciate ligament,ACL）的临床疗效差异。方法从2008年2月-2010年11月,对156例膝关节ACL损伤患者行关节镜下ACL重建术,其中自体骨-髌腱-骨（B-PT-B）组39例,同种异体跟腱组53例,LARS人工韧带组64例。通过一般情况、前抽屉试验、Lachman试验、轴移试验、Lysholm、IKDC膝关节评分进行临床疗效评价。结果所有患者随访12-38个月,平均21个月,术后3、6个月各组膝关节Lysholm、IKDC评分,LARS组明显高于其余2组（P〈O．05）。异体跟腱组与自体B-PT-B组相比,差异无统计学意义（P〉0．05）。术后12月及最后随访时,LARS组略高于其余2组,但3组间差异无统计学意义（P〉0．05）。结论在关节镜下应用3种不同移植物重建前交叉韧带的近期疗效均较为满意,LARS组可在术后早期进行膝关节功能活动近期效果优于自体B-PT-B组和异体跟腱组。对于年轻患者．尤其是运动员ACL损伤。LARS人工韧带是一种理想移植材料。     

膝关节镜下同种异体髌骨-髌腱-胫骨移植物重建交叉韧带41例

目的探讨应用同种异体髌骨-髌腱-胫骨(B-PT-B)移植物在关节镜监视下重建膝关节前交叉韧带(ACL)、后交叉韧带(PCL)的体会及疗效观察。方法对32例ACL断裂、6例PCL断裂、3例ACL及PCL同时断裂共41例43个膝关节的患者,在关节镜下应用由山西骨组织库提供的同种异体B-PT-B移植物(包括新鲜及经辐射两种材料)进行膝关节交叉韧带重建,同时处理合并伤,观察手术前后生化、免疫学指标的变化及全身及膝关节局部反应,定期检查康复锻炼、关节功能等情况,应用Lysholm评分进行功能评定。结果除1例于术后10d因急性化脓性扁桃体炎致患膝感染(经关节腔冲洗、应用抗生素后治愈),其余患者均未见排异反应及感染发生。38例获得随访,时间4-40个月,所有患膝关节屈伸活动度正常,无膝前区疼痛;6例患者体检有弱阳性或阳性体征,其中2例ACL及PCL均重建者术后抽屉试验阳性需再次行紧缩及后外侧结构重建手术,1例ACL重建者于术后2个月爬山跌倒致重建ACL部分撕裂伤而行紧缩术。术后Lyaholm评分为(92.20±2.14)分,与术前(57.63±7.14)分比较,差异有统计学意义(P<0.01)。结论应用同种异体B-PT-B在关节镜下重建膝关节ACL、PCL有良好的手术疗效,可避免自体移植物取材后造成的并发症;同种异体B-PT-B移植物是重建ACL、PCL理想的替代材料。     

半腱肌股薄肌腱打结骨栓嵌入固定镜下重建前交叉韧带的初步观察

目的　探讨自体半腱肌、股薄肌腱中间打结、骨栓嵌入挤压固定法在关节镜下重建前交叉韧带 (ACL)的可行性。　方法　 15例前ACL损伤 ,采用自体半腱肌、股薄肌腱中间打结 ,骨栓嵌入挤压固定法镜下重建ACL。半腱肌腱和股薄肌腱预张力后 ,肌腱中间打结嵌入 12mm×6mm骨栓。经ACL导向器打入导针 ,用环钻建立股骨和胫骨隧道。胫骨和股骨隧道下 1 3的直径为 5～ 7mm ,股骨隧道近 2 3为 11mm。将肌腱从股骨隧道的近端经关节腔牵入胫骨隧道 ,将肌腱拉紧、膝关节屈伸活动 2 0次 ,使肌腱结和骨栓完全嵌入瓶颈状股骨隧道内。将 4股肌腱从胫骨隧道和其下方 10mm处分别穿出 ,交叉打结并缝合固定在骨桥上。　结果　 15例患者得到随访 ,关节稳定 ,功能恢复正常。按膝关节疗效评定标准 ,优 11例 ,良 2例 ,可 2例 ,优良率 86.7%。　结论自体肌腱打结骨栓嵌入固定法重建ACL为生物固定 ,创伤小 ,固定可靠 ,费用低 ,有利于愈合 ;可免除金属内固定物 ,术后不影响MRI检查     

3D打印股骨隧道精确定位法结合LARS人工韧带移植在前交叉韧带重建手术中应用

目的评价应用3D打印股骨隧道定位器精确定位结合LARS人工韧带移植在前交叉韧带(ALC)重建手术的临床效果。方法选取2013年10月至2016年8月接受关节镜下应用LARS人工韧带重建ACL的患者42例,其中,应用3D打印股骨定位器的21例患者为3D组,术中应用传统定位器进行股骨隧道定位21例患者为对照组。评估两组平均手术时间、术后膝关节X线影像、术后并发症及膝关节功能评分。结果与对照组比较,3D组平均手术时间短、术后并发症少。两组间膝关节功能评分比较,术后1周有明显差异(P<0.05),术后3月无统计学差异(P>0.05)。结论应用3D打印个性化股骨隧道定位法定位人工韧带股骨隧道位置,可精准定位术前评估的最佳位点,明显缩短手术时间,减少术后膝关节并发症的发生,达到快速康复的目的。     

One-stage anatomic double-bundle anterior and posterior cruciate ligament reconstruction using the autogenous hamstring tendons

This is the first report of an anatomic double-bundle ACL and PCL reconstruction procedure with the autogenous hamstring tendons. We prepare two pairs of the doubled tendon grafts, to which a polyester tape and an Endobutton-CL are attached using our original technique at the tibial and femoral ends, respectively. Under arthroscopic and fluoroscopic observations, two tibial tunnels for PCL reconstruction are created so that they pass through the posteromedial and anterolateral bundle attachments, respectively. Then, we create two tibial tunnels for anatomic double-bundle ACL reconstruction so that each tunnel axis is aimed at a targeted point on the femoral condyle. Using the outside-in technique, two femoral tunnels for PCL reconstruction are created so that the tunnel outlets are located at the center of the anterolateral and posteromedial bundle attachments. Then, two femoral tunnels for anatomic double-bundle ACL reconstruction are created with the trans-tibial tunnel technique. After the two grafts have been placed for PCL reconstruction, the two grafts are placed for ACL reconstruction. After all the femoral graft ends are fixed, the knee joint is reduced to the full extension position, and then, the four tibial tape portions are simultaneously fixed with the turn-buckle stapling technique.     

Diagnostic evaluation of posterior cruciate ligament injuries

The posterior cruciate ligament is one of the most controversial issues in sports medicine. There is no consensus in the literature with respect to its incidence, natural history, and treatment indications. Injury evaluation is often underestimated, with the result of misdiagnosed injury or wrong treatment. This contribution reviews the principles of diagnostic evaluation of posterior cruciate ligament injuries.     

Simultaneous anterior and posterior cruciate ligament reconstruction in chronic knee instabilities: surgical concepts and clinical outcome

The purpose of this study was to evaluate the clinical results of simultaneous arthroscopically assisted reconstruction of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) using autogenous tendon grafts in chronic knee injuries. Nineteen patients (17 men and 2 women) with chronic multi-ligamentous injuries underwent one-stage ACL and PCL reconstruction. ACL, PCL and medial collateral ligament were reconstructed in seven knees, and ACL, PCL and posterolateral structure were reconstructed in two knees. Function of the operated knee was evaluated according to the International Knee Documentation Committee (IKDC) and Lysholm scale. Anterior and posterior knee laxity was examined with a KT-2000 arthrometer. Eighteen of 19 patients were able to return for follow-up and were evaluated objectively and subjectively. The average patient age at surgery was 30.5 years, and the average postoperative follow-up was 3.5 years. No patients showed loss of knee extension more than 5 degrees , while three patients revealed loss of knee flexion more than 16 degrees . The mean postoperative total anterior-posterior side-to-side difference was 1.9 +/- 1.5 mm at 20 degrees and 2.1 +/- 1.9 mm at 70 degrees . The average of the Lysholm score was 95.1 points at the final follow-up. At the IKDC evaluation, three patients were grade A, 11 were grade B, 3 were grade C, and 1 patient was grade D. The results showed the effectiveness and safety of one-stage reconstruction of combined ligamentous injuries of the knee that can adequately restore satisfactory stability.     

Prevention of anterior cruciate ligament injuries in soccer

Proprioceptive training has been shown to reduce the incidence of ankle sprains in different sports. It can also improve rehabilitation after anterior cruciate ligament (ACL) injuries whether treated operatively or nonoperatively. Since ACL injuries lead to long absence from sports and are one of the main causes of permanent sports disability, it is essential to try to prevent them. In a prospective controlled study of 600 soccer players in 40 semiprofessional or amateur teams, we studied the possible preventive effect of a gradually increasing proprioceptive training on four different types of wobble-boards during three soccer seasons. Three hundred players were instructed to train 20 min per day with 5 different phases of increasing difficulty. The first phase consisted of balance training without any balance board; phase 2 of training on a rectangular balance board; phase 3 of training on a round board; phase 4 of training on a combined round and rectangular board; phase 5 of training on a so-called BABS board. A control group of 300 players from other, comparable teams trained normally and received no special balance training. Both groups were observed for three whole soccer seasons, and possible ACL lesions were diagnosed by clinical examination, KT-1000 measurements, magnetic resonance imaging or computed tomography, and arthroscopy. We found an incidence of 1.15 ACL injuries per team per year in the control group and 0.15 injuries per team per year in the proprioceptively trained group (P<0.001). Proprioceptive training can thus significantly reduce the incidence of ACL injuries in soccer players.     

关节镜下运用4股腘绳肌腱同期重建前后交叉韧带损伤

目的 关节镜下运用Intrafix和可吸收界面螺钉固定自体4股腘绳肌腱，同期重建前交叉韧带（anterior cruciate ligament，ACL）、后交叉韧带（posterior cruciate ligament，PCL），评估其疗效。方法 ACL、PCL同时损伤的患者16例，关节镜下以自体4股胭绳肌腱作为重建移植物，应用可吸收界面螺钉固定移植物股骨端，Intrafix钉鞘和可吸收锥形钉固定胫骨端，同期行ACL和PCL损伤重建术。7例行内侧副韧带修补，4例行外侧副韧带复合结构修复，2例行内外侧同时修复。所有患者按照国际膝关节评分委员会（International Knee Documentation Committee，IKDC）评分标准进行术前评估，均为D级。术前Lysholm评分为（36．5±3．7）分。结果 随访时间为12～18个月，平均14．6个月。终末随访时，IKDC总体评价：A级6例（38％），B级9例（56％），C级1例（6％），无D级患者。Lachman试验0～2mm8例；3～5mm6例；6～10mm2例（P〈0．05）。屈70°前后总位移0～2mm10例；3～5mm5例；6～10mm1例（P〈0．05）。屈70°后位移0～2mm12例；3～5mm4例（P〈0．05）。术后2个月Lysholm功能评分为（90．4±2．9）分，终末随访时为（93．4±3．5）分，与术前相比差异均有统计学意义（P〈0．05）。结论 关节镜下以自体4股胭绳肌腱作为移植物，应用可吸收界面螺钉、Intrafix钉鞘和可吸收锥形钉固定股骨胫骨端同期重建ACL和PCL损伤，有利于早期积极的功能康复，膝关节功能恢复满意。