关节镜下同种异体跟腱经股骨双束双隧道移植重建后交叉韧带

【目的】 探讨在关节镜下采用同种异体跟腱经股骨双束双隧道移植重建膝关节后交叉韧带的手术方法和临床疗效。方法 对2002年3月至2003年4月收治的后交叉韧带损伤致膝关节不稳的10例患者，选用同种异体跟腱作移植物供体，于关节镜下完全经前方入路行后交叉韧带重建手术治疗。手术方法：异体跟腱直径12mm，长20～140mm，带直径10mm的圆柱形跟骨块，跟骨端固定于胫骨骨隧道内，腱性部分按3：2（即7mm：5mm）比例分为两束分别固定于股骨内髁前外（AL）和后内（PM）两个骨隧道内行双束双隧道重建。术后伸膝位支具或石膏托固定4周。以膝关节Lachman试验和后抽屉试验及膝关节Lysholm功能评分标准作为疗效评定指标。结果 所有病例随访12-48月，平均32月。10例患者术后膝关节不稳症状均消失，关节前后方向稳定性恢复，术后膝关节Lachman试验及后抽屉试验均为阴性，屈伸膝活动范围正常；膝关节Lysholm功能评分术前58分，术后6周93分，功能优9例，良1例，优良率100％；临床观察，与异体组织免疫排斥反应相关的表现仅1例轻微发烧（＜38℃），所有病例均未发生手术并发症。术后随访均未见韧带再松弛，取得满意临床疗效。结论 同种异体跟腱经股骨双柬双隧道移植重建膝关节后交叉韧带是一种既避免移植物供区损伤又符合后交叉韧带生物力学解剖重建的新型临床治疗方法，近期效果好，远期效果还需进一步观察研究。

Arthroscopic Transtibial Double-bundle Posterior Cruciate Ligament Reconstruction Using Calcaneal-tendon Allograft

OBJECTIVE: To evaluate the surgical approach and the clinical outcome of arthroscopic transtibial double-bundle and double-tunnel posterior cruciate ligament(PCL) reconstruction using calcaneal-tendon allograft. METHODS : Ten patients with knee instability caused by PCL rupture were treated by arthroscopic PCL reconstructions using calcaneal-tendon allograft only by anterior approach between March, 2002 and April, 2003. First, the square bone block 10 mm in diamter, which is connected with a band of calcaneal tendon 12 mm in diameter, was fixed into the tibial tunnel. Then, the tendon was divided into two parts with a proportion of 3 : 2 (7 mm : 5 mm), which were fixed into the anterolateral (AL) and posteromedial (PM) tunnels in medial femoral condyle respectively. The knees were fixed with plaster slabs or braces for 4 weeks after operation. The periods of follow-up were 12 to 48 months (average, 32 months),and the outcome was evaluated by Lachman's test, posterior drawer test (PDT), and Lysholm scorses. RESULTS: Knee instability was seen no more in the 10 cases after operation. Recovery of stability in coronary axis was apparent. The results of Lachman's test and PDT were both positive in every case before operation, but became negative after operation. Extension and flexion of knee joints became normal. Lysholm scores rose from 58 (pre) to 93 (post). Joint function of nine cases reached excellent level, one case reached good level, and the total rate of excellence and good was 100%. Clinical observations suggested that immunological rejection was mild (only one patient had a low fever); meanwhile, no surgical complication happened. During 48 months, no ligament looseness was observed. Satisfactory clinical outcome was achieved in the whole group. CONCLUSION: Double-bundle and double-tunnel PCL reconstruction using calcaneal-tendon allograft is a good surgical approach, which not only avoids injuring the donor area, but also accords with the anatomical structure of PCL. The short-term outcome has been proved, but long-term outcome needs more observations.