关节镜下保留韧带残端的前交叉韧带重建

目的 评价保留韧带残端的前交叉韧带(ACL)重建的近期临床效果,探讨ACL胫骨残端在重建术后韧带化及膝关节本体感觉恢复过程中的作用.方法 2007年1月至2009年1月,对82例ACL断裂患者行关节镜下保留韧带残端的ACL单束重建,男53例,女29例;年龄18～41岁,平均28.2岁.受伤至手术时间为3周～22个月,平均3个月.82例患者均为ACL完全断裂,其中体部断裂77例,股骨起点断裂5例.术中病理检查观察韧带残端血管分布,尽可能保留韧带残端及表面滑膜鞘,重建的韧带自ACL残端中通过并被残留的滑膜鞘包裹.术后随访时通过Rolimeter试验检测膝关节前向稳定性,采用Lysholm膝关节评分、Tegner评分、国际膝关节文献委员会(IKDC)评分等评价术后疗效.结果 ACL残端病理检查显示残端韧带纤维间有血管分布,炎性细胞浸润,靠近胫骨止点处和新鲜损伤时血管分布较多.82例患者术后随访13～37个月(平均20个月).末次随访时,79例患者(96.3%)Lachman试验阴性.Rolimeter检查显示双侧膝关节前向松弛度差值由术前平均(7.3 ±2.6)mm减少至末次随访时(2.3 ±1.5)mm(t=1.981,P=0.023).Lysholm评分由术前平均(61.2 ±7.6)分改善至末次随访时(91.5 末4.5)分(t=2.915,P=0.002).Tegner评分由术前平均(3.7 ±1.4)改善至末次随访时(6.5±1.2)分(t=2.189,P:0.012).IKDC主观评分由术前平均(65.1±7.9)分改善至末次随访时(93.4±5.7)分(t=3.286,P=0.001).所有患者轴移试验检杏均为阴性,膝关节活动度正常.结论 保留牵张胫骨残端的ACL重建能够建立具有良好稳定性的膝关节,近期临床疗效良好.ACL胫骨残端组织有利于韧带的组织再血管化过程及本体感觉的恢复.

Arthroscopic anterior cruciate ligament reconstruction with remnant preservation

Objective To evaluate the clinical value of arthroscopic anterior cruciate ligament(ACL)reconstruction with remnant preservation in enhancing the revascularization of the graft and preserving proprioceptive function.Methods From January 2007 to January 2009,82 cases of ACL rupture were treated with single-bundle ACL reconstruction in which the ligament remnants were preserved.The tibial remnant and the synovial shell were preserved as much as possible.Grafts were pulled intra-articularly through the tibial remnant under arthroscopic visualization.The ACL tibial remnant was compacted by the tendon passage.All patients were followed up for more than one year as scheduled.Rolimeter measurement,Lysholm,Tegner and International Knee Documentation Committee(IKDC)rating scale were used to evaluate the curative effects at the last follow-up.Results At the last follow-up,79 patients(96.3%)had negative Lachman results,and only 3 patients had positive Lachman results.Rolimeter examination showed that the average difference of anterior laxity was(7.3± 2.6)mm before operation and(2.3 ± 1.5)mm at the final follow-up(t = 1.981,P =0.023).All patients showed a negative pivot shift test and a normal range of motion.The average Lysholm score was 61.2 ±7.6 before operation and 91.5±4.5 at the last follow-up(t =2.915,P = 0.002).The average Tegner score was 3.7 ± 1.4 before operation and 6.5 ± 1.2 at the last follow-up(t = 2.189,P = 0.012).The average IKDC score was 65.1 ± 7.9 before operation and 93.4 ± 5.7at the last follow-up(t = 3.286,P = 0.001).Conclusion Preserving the remnant tissue of the ACL for ACL reconstruction is beneficial for the graft revascularization and rehabilitation of proprioceptive function.