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.

Arthroscopic reconstruction of anterior cruciate ligament of knee by using autologous hamstring tendon

Objective To study the therapeutic efficacy of arthrnscopic reconstruction of anterior cruciate ligament （ACL） with autologous hamstring tendons. Methods From March 2006 to December 2007,39 ACL injured knees underwent arthroscopic hamstrings graft reconstruction. After being harvested through a samll anterior incision of the knee, the ,hamstring graft was folded into quadrupled, and was then anchored into the tibial and the femoral tunnels using the Endobutton and the absorbable screw, respectively. The anatomical structure and the biomechanical function of the ACL were restored. Results All patients achieved healing by the first intention. The extension and flexion functions were restored to normal at 8 - 10 weeks.The patients were followed up for 3 - 15 months. The results of drawer test and Lachman test were positive in 2 patients and suspiciously positive in 6 patients. The results were excellent in 23 patients, good in 11, and fair in 3. Lysholm knee scores were （45.3±4.2） preoperatively and （87.6±4.6） postoperatively,showing significant difference （ P 〈0.01）.Conclusions Hamstring tendons have a high resistance to strain and a good stiffness. Arthroscopic quadrupled Endobutton procedure is a reliable method for ACL reconstruction.