关节镜下横杆式固定重建膝前十字韧带的中期疗效观察

目的 评价关节镜下自体腘绳肌腱移植、横杆式固定(transfix)重建膝关节前十字韧带(anterior cruciate ligament,ACL)的中期临床疗效.方法 自2002年8月至2003年12月对38例膝关节ACL断裂患者应用自体腘绳肌腱重建ACL、股骨端采用横杆式固定、胫骨端采用界面螺钉固定.男21例,女17例；年龄19～48岁,平均28.4岁；左膝24例,右膝14例.运动伤27例,交通伤2例,跌倒扭伤2例,余7例无明显外伤.急性损伤6例,陈旧性损伤32例.术前体检:前抽屉试验阳性35例,弱阳性1例,阴性2例；Lachman征阳性37例,弱阳性1例.以Lysholm评分评价中期临床疗效,以MRI及X线观察移植物以及骨隧道变化情况.结果 38例患者中36例获得随访(随访率94.7％),随访时间6.3～7.6年,平均6.8年.所有患者关节活动度正常,Lysholm评分由术前(64.4±4.52)分提高到(85.6±4.60)分,差异有统计学意义.X线及MRI发现3例股骨及胫骨隧道均扩大,5例股骨隧道扩大,3例胫骨隧道近端扩大.未见关节间隙变窄.1例患者在术后4年因外伤再次致ACL断裂,行关节镜下ACL翻修术,采用同种异体肌腱移植物,股骨端及胫骨端采用可吸收挤压钉固定.结论 应用腘绳肌腱、股骨侧横杆式、胫骨侧界面挤压螺钉固定重建膝关节ACL可以获得较为满意的关节活动度及关节稳定性,中期疗效佳.

The mid-term results of arthroscopic anterior cruciate ligament reconstruction using Transfix technique

Objective To evaluate the mid-term results of arthroscopic anterior cruciate ligament (ACL) reconstruction using Transfix technique. Methods From August 2002 to December 2003, 38 patients (24 left knees and 14 right knees) with ACL ruptures underwent arthroscopic ACL reconstruction with hamstring tendon using Transfix femoral fixation and interference screws tibial fixation. There were 21 males and 17 females, aged from 19 to 48 years (average, 28.4 years). The causes of injury included sports injury in 27 cases, traffic injury in 2 cases and fall injury in 2 cases, and 7 patients had no significant injury. There were 6 cases of acute injury and 32 cases of old injury. Anterior drawer test was positive in 35 cases, weak positive in 1 case and negative in 2 cases. Lachman test was positive in 37 cases, and weak positive in 1 case. The Lysholm score was used to evaluate the results. Moreover, X-rays and MRIs were used to observe the conditions of graft and bone tunnel. Results Thirty-six patients were followed up for 6.3 to 7.6 years (average, 6.8 years). All patients had normal joint range of motion. The Lysholm score improved from preoperative 64.4±4.52 to postoperative 85.6±4.60, and the difference was statistically significant (P < 0.05). The X-rays and MRIs showed femoral and tibial tunnel enlargement in 3 cases, femoral tunnel enlargement in 5 cases and tibial tunnel enlargement in 3 cases. No joint space narrowing was found in all patients. One patient underwent arthroscopic revision ACL reconstruction with allograft tendon using bioabsorbable interference screws fixation on both tibial and femoral sides for re-rupture of ACL 4 years after operation due to trauma. Conclusion Arthroscopic ACL reconstruction with hamstring tendon using Transfix femoral fixation and interference screws tibial fixation is an effective method, which can provide satisfactory joint range of motion and stability.