后十字韧带合并后外侧韧带结构损伤的关节镜下重建

目的 介绍后十字韧带合并后外侧韧带结构损伤的关节镜下重建及加强方式,总结其初期临床结果.方法 2006年11月至2007年10月,20例陈旧性后十字韧带合并后外侧韧带结构损伤患者采用八股自体胭绳肌肌腱双束重建后十字韧带、自体半腱肌肌腱加强后外侧韧带结构的手术方法.移植物采用微型钢板纽扣进行悬吊式固定.根据IKDC、Lyshohn和Tegner评分标准进行膝关节功能评估.结果 术后随访1～2年,平均(15.5±3.3)个月.末次随访时,患者伸膝活动均正常,1例屈膝受限15°,5例屈膝受限5°.后抽屉试验阴性17例,Ⅰ度阳性2例,Ⅱ度阳性1例.KT-1000检查(屈膝90°,30 kg)双侧松弛度差异平均为(2.35±1.35)mm.18例(90%)屈膝30°位外侧膝关节间隙增宽小于5 mm,2例(10%)分别为5 mm和6 nun.屈膝30°位小腿外旋角度较健侧增加均小于5°,平均为2.10°±2.67°.IKDC、Lysholm和Tegner评分分别为(90.00±3.49)分、(91.90±2.57)分和(6.50±0.69)分,与术前差异均有统计学意义.IKDC膝关节韧带评级15例(75%)正常,4例(20%)接近正常,1例(5%)异常.结论 采用八股自体胴绳肌肌腱双束重建后十字韧带,同时用自体半腱肌肌腱加强后外侧韧带结构能够恢复后十字韧带和后外侧韧带结构损伤后的膝关节稳定性.

Posterior cruciate ligament reconstruction combined with knee posterolateral complex reconstruction

Objective To introduce the method of posterior cruciate ligament (PCL) reconstruction combined with knee posterolateral complex (PLC) reconstruction through arthroseopy and to evaluate short-term outcomes. Methods Twenty cases of combined PCL and PLC injuries were treated with two-bundle PCL reconstruction with eight strands of autogenous hamstring tendons and PLC reinforcement with autoge-nous semitendinosns tendon. The semitendinosus tendon and gracilis tendon from the uninjured lower limb were harvested to reconstruct PCL, and the semitendinosus tendon from the injured leg was used to reinforce PLC. The grafts were fixed with a suspension technique by mini-plates and mini-buttons. The patients were followed up for more than one year and evaluated according to IKDC, Lysholm and Tegner rating scales.Results At the last follow-up, all patients showed normal knee extension. One patient had 15°of flexion limitation, and five had 5° of flexion limitation. Posterior drawer test were negative in 17 patients, grade Ⅰpositive in 2, and grade Ⅱ positive in one patient. KT-1000 examination averaged (2.35±1.35) ram. Varusstress test showed less than 5 mm increase of lateral patellofemoral joint space in 18 patients at 30° flexionof knee joint, 5 mm and 6 mm increase was noted only in one respective patient. External rotation examina- tion showed less than 5° increase in all eases compared with the intact knee,with an average of 2.10°±2.67°.IKDC subjective, Lysholm, and Tegner scores were 90.00±3.49, 91.90±2.57 and 6.50±0.69 respectively. Ac-cording to objective IKDC evaluation, the results were graded as normal in 15 patients (75%), nearly normal in 4 (20%), and abnormal in 1 patient (5%). Conclusion Two-bundle PCL reconstruction with eight strands of hamstring tendons, combined with PLC reinforcement can reliably restore knee stability.