应用半腱肌、股薄肌和髌韧带在关节镜下重建前交叉韧带65例

目的 探讨应用髌韧带（bone-patellar tendon-bone,BTB)和半腱肌、股薄肌（bone-ham-string-bone,BHB)在关节镜下修复前交叉韧带（anterior cruciate ligament,ACL)损伤的临床疗效。手术要点及关节功能改善情况。方法 在膝关节镜直视下,选用自体BTB和BHB行ACL竽建手术65例,其中BTB重建30例,BHB重建31例,股四头肌腱重建4例,结果 随访时间1个月-3年,手术前Lachman和Piveot shift试验从阳性转为阴性,按日本骨科学会膝关节疗效评定标准,优48例,良7例,可10例,本组病人2个月后均恢复原来日常活动,半年后恢复体育活动,结论 应用BTB、BHB在关节镜下修复ACL损伤,术中等长点的选择是手术关键,坚强固定是早期康复训练的前提。     

自体半腱肌腱股薄肌腱重建前交叉韧带术后肌腱再生的临床研究

目的 :应用超声仪观察切取半腱肌腱股薄肌腱重建前交叉韧带后肌腱的再生情况。方法 :39例用自体半腱肌腱股薄肌腱重建前交叉韧带患者 ,术后平均 13个月行双侧半腱肌腱股薄肌腱超声检查 ,了解肌腱再生情况并对比其长度和截面积的变化。结果 :超声检查显示 39例患者中有肌腱再生 2 6例 ,再生率为 72 %。再生肌腱长度和截面积与对侧肌腱相比无明显差异。 2 6例患者半腱肌腱股薄肌肌腹有萎缩。结论 :切取半腱肌腱股薄肌腱重建前交叉韧带后肌腱能够再生。     

半腱肌腱和股薄肌腱重建前交叉韧带后Cyclops综合症临床研究

目的:研究采用自体半腱肌腱和股薄肌腱重建前交叉韧带(ACL)后膝关节内Cyclops综合症的发生情况。方法:回顾性研究2004~2005年197例采用半腱肌腱和股薄肌腱重建ACL后取出内固定患者,平均年龄25.85岁。取内固定时通过病史、体征、X线及KT-2000评估膝关节功能,手术同时进行膝关节镜探查,观察关节内髁间窝增生物情况,并进行统计分析。结果:所有患者中发现有髁间窝结节样增生物(统称为Cyclops病变)形成28例,其中2例伴有伸膝受限(同健侧膝关节比较),Cyclops综合症的发生率为1.02%(2/197)。无Cyclops病变的患者中伸膝受限5例。根据是否存在Cyclops病变将所有患者分为Cyclops组和非Cyclops组,两组伸膝受限发生率的差异无统计学意义(2χ=0.268)。Cyclops病变的病理表现为增生变性的瘢痕样组织,无骨性成分。Cyclops组患者取钉时KT-2000检查结果显示134N下差值平均为1.8mm,有24例均恢复到原来的运动水平。结果表明,采用半腱肌腱和股薄肌腱重建前交叉韧带后Cyclops病变发生率较高,但产生伸膝受限(Cyclops综合症)的发生率低。     

膝关节镜下半腱肌及股薄肌肌腱重建前交叉韧带的临床观察

目的探讨膝关节镜下前交叉韧带重建的方法和效果。方法回顾分析26例膝关节镜下应用自体半腱肌及股薄肌腱以界面挤压螺钉及Endobutton固定重建前交叉韧带的临床资料,对患膝关节功能进行评估。结果术后随访12-18个月,根据Lysholm膝关节评分标准,由术前（54．7±9．13）分提高到术后（86．6±6．97）分。结论膝关节镜下采用自半腱肌及股薄肌肌腱重建前交叉韧带的方法可行,疗效满意,可作为重建前交叉韧带的方法广泛应用。     

关节镜下自体半腱及股薄肌腱重建膝前交叉韧带

 目的 探讨关节镜下以自体半腱肌、股薄肌腱重建膝前交叉韧带(ACL)的手术方法及疗效.方法 自2006年3月～2007年12月,关节镜下绳肌腱修复膝前交叉韧带损伤39例.膝前小切口取半腱肌腱、股薄肌腱修整、对折后成四股,分别建立胫骨隧道及股骨隧道,用Endobutton和生物可吸收挤压螺钉固定肌腱,重建ACL的解剖结构和生理功能.术后即行功能锻练.结果 术后患者伤口均Ⅰ期愈合,8～10周膝关节屈伸功能恢复正常.随访时间3～15个月,平均8个月.抽屉试验和Lachman试验阳性者2例,可疑阳性者6例;余患者均为阴性.根据敖英芳临床判断标准,本组优23例,良11例,中3例,差2例.Lysholm评分术后(87.6±4.6),与术前(45.3±4.2)比较,差异显著(P<0.01).结论 绳肌腱具有良好的抗拉强度和刚度,在关节镜下用四股绳肌腱重建膝前交叉韧带是一种疗效可靠的治疗方式.     

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...     

关节镜下钮扣钢板固定四股半腱肌重建膝关节前交叉韧带

目的 探讨关节镜下钮扣钢板固定四股半腱肌重建膝关节前交叉韧带的治疗效果。方法 关节镜下四股半腱肌重建膝关节前交叉韧带20例。术前MRI证实膝关节前交叉韧带断裂,术中关节镜下均证实膝关节前交叉韧带断裂,四股半腱肌重建者用钮扣钢板固定。结果 平均随访7个月,无1例打软腿,假交锁症状消失,关节痛消失。X线见内固定物与术后一致,无移位。Lysholm膝关节功能评分：术前平均54.5,随访评分95.6。结论 关节镜下四股半腱肌重建膝关节前交叉韧带临床效果好,并发症少,手术时间短。     

关节镜下双股半腱肌重建膝关节前交叉韧带80例

目的　介绍关节镜下双股半腱肌闭合拉出钢板法重建前交叉韧带(ACL)手术操作及其技巧。　方法　设计应用关节镜下双股半腱肌闭合拉出钢板法重建ACL,对80例患者手术操作经验进行总结。　结果　本组80例完成关节镜下重建ACL手术,平均手术时间为80min。术中出现穿导针弯曲、断裂,微型器械断裂,微型钢板骨隧道内受阻等情况。本组病例平均随访16个月,除2例术膝轻度胀痛外,其余患者无主诉症状。所有病例感觉膝部稳定,恢复原工作。Lysholm膝部评分,术前(48±12)分,术后(92±4)分（P<0．01）。　结论　关节镜下双股半腱肌闭合微型钢板固定法重建ACL,手术效果良好。临床实践中应掌握手术原则,严格按手术程序操作。     

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     

关节镜下双股半腱肌腱重建后交叉韧带

目的探讨关节镜下双股半腱肌腱转移重建后交叉韧带(PCL)术的临床疗效。方法采用开口螺旋肌腱剥离器剥离半腱肌腱,保留肌腱远侧附着点,在近侧腱肌交界处切断,对折成两股编织,转移到关节镜下重建PCL。隧道内口侧使用可吸收挤压螺钉固定,股骨隧道外口加强固定。结果手术16例,平均随访23.5个月。Larson评分由术前58分提高到93分,Lysholm评分由术前54分提高到90分,所有患膝术前后抽屉试验及Lachman试验均阳性,术后仅2例抽屉试验弱阳性,l例Lachman试验弱阳性。结论(1)关节镜下使用双股半腱肌腱转移重建PCL较B-PT-B通过隧道时柔顺通畅。(2)隧道内口可吸收螺钉挤压固定,愈合后内口消失,可避免韧带撞击内口使之逐渐扩大引起重建韧带松弛。(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。     

Arthroscopic intra- and extra-articular anterior cruciate ligament reconstruction with gracilis and semitendinosus tendons

Numerous surgical procedures have been developed and used for anterior cruciate ligament (ACL) reconstruction. Patellar tendon is probably the most common graft used, but gracilis and semitendinous tendons present some interesting advantages: small incision, large graft when doubled, characteristics close to ACL, rapid harvest. We describe a combined intra- and extra-articular arthroscopic ACL reconstruction using hamstring tendons which includes some original steps. The tendons are harvested, leaving the distal insertion intact, and sutured together. After drilling of the tibial tunnel, an over-the-top arrangement is formed, creating a groove in the posterolateral aspect of the femur. The tendons are then fixed with double staples in the groove, and their remaining part is fixed distally to Gerdy’s tubercle passing under the fascia, but over the lateral collateral ligament (LCL). This technique ensures sufficient strength in the graft and permits correction of any associated instability, because of the presence of the extra-articular portion of the tendons. Furthermore, the over-the-top arrangement reduces trauma and possible pitfalls related to tunnel construction and permits isometry of the extra-articular portion to be established. Forty patients involved in sports activity were prospectively selected and evaluated at a minimum 2 years’ follow-up. IKDC score and Lysholm score were used for clinical evaluation, and the KT-2000 was used for instrumental laxity measurements. Resumption of sport and time to that point were recorded as well as Tegner activity score. We had 92.5% normal and fairly normal knees according to IKDC score and only 7.5% abnormal knees. Mean Lysholm score was 95. Mean Tegner score was 7.2. KT-2000 showed a mean injured/uninjured difference of 2.1 mm. In all, 90% of patients resumed sports at the same level, 67.5% in 3–4 months and 27.5% in 4–6 months. The highly satisfactory results of this series with no major complications confirm the reliability of this techinque and the possibility of guaranteeing functional behaviour in the knee. Received: 5 April 1997 Accepted: 25 July 1997     

Reconstruction of the posterior cruciate ligament with LAD-augmented semitendinosus and gracilis tendons: a preliminary report

We present our technique for reconstruction of the posterior cruciate ligament (PCL) using the semitendinosus and gracilis tendons with the Kennedy ligament augmentation device (LAD). The safe and excellent exposure of the posterior aspect of the knee allowed us to identify the most isometric position in the intercondylar notch of the femur. In addition to this advantage, firm fixation of the LAD-augmented tendons with staples prevented the tibia from sagging posteriorly during early protected motion of the knee. Evaluation of 12 patients followed for more than 2 years showed 9 (75%) good results. In this small series no correlation was found between clinical results and the number of major structures injured, indicating that postoperative care is as important as isometric placement of the PCL in obtaining satisfactory results.     

Morphometry of the semitendinosus and gracilis tendons with application to anterior cruciate ligament reconstruction

The length and cross-sectional area of human semitendinosus and gracilis tendons were measured in both single- and multi-strand configurations for the purpose of anterior cruciate ligament graft preparation. The average lengths of the semitendinosus and the gracilis tendons were 235±20 mm (mean±SD) and 200±17 mm, respectively. The cross-sectional area of a doubled semitendinosus tendon (two strands) was significantly less than that of a 10-mm-wide patellar tendon graft (P<0.001). The cross-sectional area of the tripled semitendinosus tendon (three strands) and the 10-mm-wide patellar tendon were similar. Doubling of the combined semitendinosus and gracilis tendons (four strands) and tripling of this combination (six strands) resulted in a significantly greater cross-sectional area in comparison to the 10-mm-wide patellar tendon (P<0.05, four strands;P<0.001 six strands). This investigation demonstrates that anterior cruciate ligament grafts fashioned using multiple-strand combinations of the semitendinosus and gracilis tendons result in a cross-sectional area that is comparable to the bone-patellar tendon-bone graft. This is an important finding since cross-sectional area reflects the intra-articular volume of collagenous tissue. This information should be helpful to surgeons considering using the hamstring tendons as an anterior cruciate ligament graft.     

Anterior cruciate ligament reconstruction with doubled semitendinosus and gracilis tendon graft in rugby players

The purpose of this study was to evaluate prospectively the results of anterior cruciate ligament (ACL) reconstruction with doubled hamstring tendon graft in a selected group of 18 rugby players. The graft was fixed with a transcondylar screw (Transfix) on the femur, and with an absorbable interference screw and a metallic staple on the tibia. All the patients followed the same rehabilitation program. Return to sports activities was allowed after 6 months. Follow-up was 2 years in all cases. The athletic level of the patients was rated according to the Tegner scoring system. Clinical results were evaluated using the International Knee Documentation Committee (IKDC) scoring system. Furthermore, an instrumented evaluation of the anterior laxity with a KT–1000 arthrometer, and an isokinetic evaluation were performed 6 and 24 months after surgery. The Tegner mean score at follow-up (8.2) was similar to that prior to injury (8.3). IKDC overall results were normal in ten cases (55.6%), nearly normal in six cases (33.3%), and abnormal in two cases (11.1%). Side-to-side difference of anterior laxity measured with KT–1000 at 6 and 24 months did not show an impairment of knee stability with time. Isokinetic evaluation showed a significant improvement on peak torque both in extension and flexion on comparison between 6- and 24-month measurements. The results reported in this study showed that the use of doubled hamstring tendon graft for ACL reconstruction in athletes that were at risk for high-energy traumas to the knees, such as rugby players, gave normal or nearly normal results in about 90% of the cases. Recovery of muscle strength was almost complete 2 years after surgery, and there was no impairment of knee stability with time.     

Arthroscopic posterior cruciate ligament reconstruction with bone-tendon-bone patellar graft

We present a retrospective study of 24 patients with chronic injury of the posterior cruciate ligament (PCL) treated by arthroscopically assisted reconstruction with bone-tendon-bone patellar autograft. At a mean follow-up of 26.5 months (range 24–53 months) the International Knee Documentation Committee (IKDC) evaluation form, Lysholm and Tegner rating systems were used to evaluate symptoms, functional limitations during sports and daily activities, and changes in activity level. At the final IKDC evaluation we found 6 patients (25%) with grade A (normal), 13 patients (54.2%) with grade B (nearly normal), 3 patients (12.5%) with grade C (abnormal) and 2 patients (8.3%) with grade D (severely abnormal). The average side-to-side difference, as measured by the KT-2000 arthrometer, was 8.38 (± 1.95) preoperatively and 4.08 (± 2.09) mm postoperatively at 89 N with the knee flexed at a neutral quadriceps knee angle of approximately 70°. The worst results significantly correlated with the time elapsed from injury to surgery (P < 0.001). The preoperative Lysholm score was 56 ± 12 (range 41–79) and at follow-up 94 ± 8 (range 76–100). The Tegner activity score improved for all patients after surgical treatment. Average preinjury score was 7.4 (range 4–9), decreasing to 3.40 (range 2–7) preoperatively and increasing to 5.4 (range 4–9) postoperatively. At follow-up, 12 patients (50%) regained to their preinjury scores after surgery. Our study suggests that this arthroscopic technique, which allows a more precise placement of tunnels, can improve the results of the PCL reconstruction with a bone-tendon-bone autograft. Received: 5 December 1996 Accepted: 14 May 1997     

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。     

关节镜下经后侧入路重建后交叉韧带

目的 探讨关节镜下经后内侧、后外侧和后纵隔入路保留板股韧带和残留的后交叉韧带(PCL)纤维重建PCL的临床效果. 方法 对9例PCL损伤患者在关节镜下结合常规关节镜入路和后内侧、后外侧入路及后纵隔入路保留板股韧带和残留的PCL纤维,应用自体腘绳肌腱重建PCL.在后外侧入路的关节镜监视下,胫骨隧道定位在PCL胫骨止点外侧关节面下方1～1.5 cm.股骨隧道经前外侧入路定位于股骨内侧髁关节软骨后方1 cm.自体肌腱移植物利用钢丝引导通过骨隧道,移植物两端用可吸收界面螺钉固定.术后6个月了解膝关节功能恢复情况.结果 9例患者均获随访,时间7～14个月,平均8.6个月.术后6个月,患者均无伸膝受限;2例有10°～15°屈膝受限;1例有Ⅰ度后抽屉试验阳性.Lysholm膝关节功能评分术前(47.6±14.9)分,术后6个月(92.9±4.6)分(P＜0.01). 结论 膝关节后内外侧入路和后纵隔入路重建PCL的方法,镜下视野清楚、无盲区,操作安全,韧带的胫骨止点定位准确,短期疗效肯定.     

Arthroscopic anterior cruciate ligament reconstruction with periosteum-enveloping hamstring tendon graft

Tendon–bone incorporation of a tendon graft within the bone tunnel is of priority concern when using for anterior cruciate ligament (ACL) reconstruction. Superior healing process and stronger healing strength can be achieved when periosteum is sutured on the tendon inserted into a bone tunnel. We applied this idea to ACL reconstruction for enhancing tendon graft–bone tunnel healing. This is a prospective clinical outcome study with this surgical technique at minimal 2 years follow-up. Periosteum-enveloping hamstring tendon graft has been used in 68 patients. Data from 62 patients who had been followed up completely were analyzed. All patients suffered from a grade 3 or higher grade of Lachman and anterior drawer test with a positive pivot-shift test. Clinical assessments included the Lysholm knee scores, International Knee Documentation Committee (IKDC) scores, KT-1000 instrumented testing, thigh muscle assessment, and radiographic evaluation. The median Lysholm knee score was 59 (40–70) and 94 (60–100) points (P<0.01) before and after surgery. After reconstruction, 81% of patients were able to return to moderate or strenuous activity. Four (6%) patients were found to exhibit grade 2 or more ligament laxity. Complete range of motion could be achieved in 86% of patients. Three patients (5%) had positive pivot shift. Finally, 92% of patients were assessed as normal or nearly normal rating by IKDC guideline. Bone tunnels enlargement of more than 1 mm was identified in 5% of femoral tunnels and 6% of tibial tunnels. The study shows that a satisfactory result can be achieved with the periosteum-enveloping hamstring tendon graft in ACL reconstruction. Periosteum can be easily harvested at the proximal tibia from a routine incision for hamstring tendon harvesting. Besides the potential for improving tendon–bone healing, enveloped periosteum may help to seal the intra-articular tunnel opening in the early postoperative period, and thus avoid synovial fluid reflux into the tunnel. Bone tunnel enlargement could be reduced.