关节镜下股四头肌腱髌骨块嵌入挤压固定重建后交叉韧带

目的设计关节镜下股四头肌腱髌骨块嵌入和异体骨栓挤压固定方法重建后交叉韧带(PCL),观察其治疗PCL损伤的疗效。方法自2002年6月-2005年12月,对13例PCL损伤患者采用关节镜下股四头肌腱髌骨块嵌入和异体骨栓挤压固定方法进行重建。股四头肌腱移植物的获取中保证髌骨上极和股四头肌腱条的连接;股骨隧道制作为“瓶颈”样;股四头肌腱移植后将与之连接的髌骨块敲击嵌入股骨“瓶颈”样隧道,胫骨隧道内用特制异体骨栓挤压固定移植肌腱。治疗效果采用Lysholm评分和国际膝关节文献委员会(IKDC)的分级标准评定。结果所有患者获得3-37个月(平均19个月)随访,无患者发生神经血管损伤、移植物失败等严重并发症。所有患者均无膝关节不稳定症状,2例患者客观检查有后向不稳定体征;除3例患者剧烈活动后关节疼痛外,其余患者关节疼痛症状明显缓解。1例患者髌骨上极股四头肌腱内有少许钙化现象。Lysholm评分术后高于术前,差异有极显著性意义(P<0．01);IKDC评定结果明显优于术前。结论采用股四头肌腱移植物对取材部位无不良影响,移植物生物力学特性更接近PCL,且可以切取任意长度和宽度,保证远大于PCL的强度。移植物固定采用本设计的骨块嵌入和异体骨栓挤压的方法,成功率高、并发症少,有明显优越性。

Arthroscopic reconstruction of posterior cruciate ligament with quadriceps tendon fixed by a patellar block and an allograft bone plug

Objective To discuss the design of arthroscopic reconstruction of posterior cruciate ligament (PCL) with quadriceps tendon fixed by a patellar block and an allograft bone plug, and its clinical outcome. Methods Thirteen patients suffering from PCL injury were treated by the technique mentioned above. The connection between quadriceps tendon and superior patellar pole was preserved in the harvest process of quadriceps tendon. The femoral tunnel was made like a bottle neck, which was clogged with the patellar bone block. The quadriceps tendon strip was fixed by an allograft bone plug pressed into the tibial tunnel. Their functional recovery was evaluated by Lysholm scoring and IKDC(International Knee Documentation Committee) criteria. Results In the average follow-up period of 19 months, there were not any severe nerve or blood vessel lesions, or failures of transplanted ligament None of the patient complained of knee instability after the operation. The pain was relieved in most patients, but three complained of pain after knee movement A little calcification was found in the quadriceps tendon at the superior patellar pole one year after the operation in the X-ray of a patient There was significant difference in Lysholm scale between pre-operation and post-operation (P < 0. 01) . Their IKDC evaluation before operation significantly improved after operation. Conclusions Quadriceps tendon harvest may have little influence on the donor area, and quadriceps tendon is similar to PCL in biomechanics and can be harvested in any length and width needed so as to provide more strength than PCL As a result, arthroscopic PCL reconstruction with quadriceps tendon fixed by a patellar block and an allograft bone plug can be done with a high success rate and few complications.