自体韧带重建术治疗前交叉韧带损伤的临床疗效

目的：探讨自体肌腱移植重建治疗前交叉韧带（ACL）损伤的手术技术，分析其疗效。方法：回顾性分析30例ACL损伤并接受自体肌腱移植重建手术患者的资料，平均随访24.1个月，探讨其手术特点及临床疗效。结果：通过抽屉实验、拉赫曼试验（Lachman试验）和内外侧应力实验分析患者术后膝关节稳定性，X线片观察重建韧带隧道愈合情况，通过核磁共振成像（MRI）观察患者手术前后ACL形态及韧带重建情况，按照国际膝关节评分委员会（IKDC）评分系统评价手术效果。全组患者无创伤性关节炎、感染和血栓等并发症。前抽屉试验、Lachman试验和内外侧应力试验由阳性转阴性，提示患者术后膝关节稳定。患者术后IKDC评分较术前明显提高（P<0.05）。X线片显示，骨隧道模糊或者消失，基本达到腱-骨愈合。MRI显示，自体肌腱移植重建后的韧带信号均匀、无迂曲，部分韧带强度得到加强。结论：精准的自体韧带移植修复重建治疗ACL损伤安全可行，并发症少，有助于快速恢复患者膝关节的稳定性。

Clinical curative effect of autologous ligament reconstruction in treatment of anterior cruciate ligament injury

Objective:To investigate the surgical technique of autologous tendon transplantation for reconstruction of anterior cruciate ligament (ACL) injury,and to analyze its curative effect. Methods:The materials of 30 patients with ACL injury who underwent autologous tendon transplantation and reconstruction were retrospectively analyzed; the average follow-up period of the patients was 24.1 months. The surgery characteristrics and clinical curative effect were explored. Results:The stability of knee joint was examined by drawer test,Lachman test,and internal and external stress tests. The healing of reconstructed ligament tunnel was observed by X-ray. The morphology of ACL and ligament reconstruction before and after operation were observed by magnetic resonance imaging (MRI). The surgical effect was evaluated according to the International Knee Documentation Committee (IKDC) scoring system. There were no severe complications such as traumatic arthritis, infection, or thrombosis in the patients. The results of anterior drawer test, Lachman test, and internal and external stress tests were changed from positive to negative, suggesting that the knee joint was stable after operation. The postoperative IKDC score of the patients was significantly higher than before operation(P<0.05). The X-ray results showed that the blurred or disappeared bone tunnel basically achieved tendon-bone healing, while the MRI showed that the reconstructed ligament signal was uniform and non-tortuous, indicating that the ligament was strengthened. Conclusion:Accurate reconstruction with autologous ligament transplantation in the treatment of ACL injury is safe and feasible with fewer complications, which is helpful to restore the stability of knee joint quickly.