自体腘绳肌腱鞘内重建前交叉韧带的临床观察

目的：观察在自体腘绳肌腱重建前交叉韧带（anterior cruciate ligament,ACL）手术中,保留原ACL胫骨残端的鞘内重建方法,对术后2年膝关节功能的影响。方法：2007年1月至2009年6月,江苏省昆山市中医院骨科收治的ACL损伤病例中,经关节镜下证实ACL胫骨端韧带残端保留1/3以上18例,男11例,女7例;平均年龄28.2岁（18～42岁）;从第1次受伤到术前平均6.8个月（1～18个月）。取自体腘绳肌腱（半腱肌腱和股薄肌腱）分别对折后编织成移植物备用。保留ACL胫骨残端,制备股骨和胫骨隧道后,将移植物经ACL残端纤维束内引入骨隧道,ACL残端呈鞘状包绕移植物。股骨端Rigidfix固定,胫骨端Intrafix固定。记录术后最后一次随访时的Lysholm评分,以评价膝关节功能;同时评价患者膝关节的稳定性和活动度;并通过再成角试验评估患膝本体感觉功能。结果：18例均获随访,时间15～24个月,平均17.3个月,术后无滑膜炎、韧带再断裂、活动明显受限等并发症。术前和术后最后一次随访时Lysholm评分,分别为（49.43±2.85）分和（91.56±4.60）分（P〈0.05）。术后最后一次随访时在屈膝15°、30°、45°位置的再成角试验,患侧与健侧差异无统计学意义（P〉0.05）。结论：保留原有残端的ACL重建术,能有效恢复膝关节功能,并有利于本体感觉的重建。

Clinical observation of anterior cruciate ligament reconstruction with tibial-remnant preserving technique using hamstring autograft

Objective: To observe the outcome of ACL reconstruction with tibial-remnant preserving technique using hamstring autograft. Methods: From January 2007 to June 2009,18 patients,including 11 male and 7 female with an average age of 28.2 years(from 18 to 42 years),received ACL reconstruction in Kunshan traditional Chinese medicine hospital,Jiangsu province. All cases were confirmed that the remnant of torn ACL were more than 1/3 by arthroscopic observation. The gracillis and semitendinosus tendons harvested from the patient were folded and weaved as a graft,which was pulled into the femoral and tibia tunnel through the sheath formed by the remnant preserved carefully,then fixed by Rigidfix at femoral side and Intrafix at tibial side respectively. The Lysholm scores were recorded at the last follow-up to evaluate the postoperative knee function. The knee stability,range of motion (ROM),and proprioception were evaluated by physical examination. Results: The average duration of follow-up of all 18 patients was 17.3 months(ranged from 15 to 24 months),no synovitis,graft tear,and ROM limitation were found. The average postoperative Lysholm score was (91.56±4.60) improved from preoperative(49.43±2.85)(P<0.05). There were no differences between bilateral knees on the knee flexion(P>0.05). Conclusion: To preserve the tibial remnant of torn ACL during ACL reconstruction had good outcomes,and contributed to recovery of knee proprioceptive function.