Inlay技术在后十字韧带和后外复合体损伤中的应用

目的 介绍inlay技术的手术适应证及早期临床疗效.方法 完成后十字韧带inlay重建及后外复合体重建手术24例,男18例,女6例;年龄19～52岁,平均33.8岁.在后十字韧带胫骨解剖附丽区制备20 mm×10 mm×8 mm骨槽,将移植物带骨块一端嵌入骨槽,用两枚空心螺钉垫片固定.关节镜监视下采用自外向内的方法制备后十字韧带股骨侧隧道,植入移植物的另一端,采用挤压螺钉固定.术前、后均行IKDC主、客观评分、查体、KT-1000测量、应力x线片测量.结果 24例患者获得随访,随访时间12～33个月,平均26.9个月.术前IKDC评分为C或D;后抽屉试验均＞2+,其中3+及4+者占83%(20/24),平均3+;KT-1000平均13.7 mm(10～29 mm);应力X线片测量平均13.9 mm(10～29 mm).术后IKDC评分为:A,5膝;B,18膝;D,1膝;后抽屉试验结果为:0(正常)5例,1+11例,2+7例,3+以上1例,平均1+,较术前平均改善2+;KT-1000平均4.8 mm(-4～18.2 mm),较术前平均改善8.9 mm;应力X线片测量平均5.3 mm(-1.7～18.2 mm),较术前平均改善8.6mm.1例失败.膝关节活动度屈膝受限平均7.5°(0°～25°).无伸膝受限的病例.结论 Inlay技术可用于重建损伤的后十字韧带和后外复合体.

Treatment of comblined posterior cruciate ligament and posterolateral complex injury using inlay technique

Objective To present preliminary clinical results of inlay technique for Dosterior cruciate ligament reconstruction.Methods Twenty-four consecutive patients with severe posterior instability and combined posterolateral complex injuries of knee underwent PCL reconstruction using inlay technique with B-PT-B autograft or allograft and Achilles tendon allograft.The patients were placed in lateral position;a 20 mm×l0 mm×8 mm trough for the inlay graft was created just in the footprint of the PCL using the posteromedial popliteal approach.The bone plug of the inlay graft was fixed with two cannulated screws and washers.the patient was converted into supine position with the affected knee in 90°with flipping technique.The femoral tunnel was made using outside-in technique and the graft was fixed with interference screw under arthroscopy.Results 24 patients were followed up at least One-year.The averaged time of follow-up was 26.9 months(12-33 months).Preoperative IKDC objective evaluation rated knees as C and D based on severely abnormal instability.Final follow-up objective IKDC evaluation distribution was as follows:A.5 knees;B,18 knees;and D,1 knees,as compared to C and D.Postoperative PD examination demonstrated the following:0 (normal)in 5 patients,1+in 11 patients,2+in 7 patients,and above 3+in 1 Datient.as compared to preoperative PD 2+or greater in all patients.No patient had＜10 mm PD preoperatively.Mean improvement in PD was 2 grades of translation as compared to preoperative exam.Final follow-up KT-1000 and stress radiography demonstrated average side-to-side difference of 4.8 mm (-4-18.2 mm) and 5.3 mm (-1.7-18.2 mm)respectively,as compared to preoperative 13.7 mm and 13.9 mm.Mean improvement was 8.9 mm and 8.6 mm.One case(4%)with 18.2 mm posterior laxity was grades as failure.Average flexion loss was 7.5°(0°-25°).None lost extension.Conclusion Indication of inlay technique includes combined PCL and posterolateral complex injuries with severe posterior instability.