自体中1／3髌韧带重建前十字韧带术后膝关节内并发症的探讨

目的探讨应用自体中1/3髌韧带移植重建前十字韧带术后膝关节内有关的并发症及其发病机制。方法1994年1月～1997年11月 ,对18例前十字韧带断裂的患者采用关节镜或小切口关节切开术 ,完成自体中1/3髌韧带移植重建前十字韧带。术后平均随访2年 ,对所有病例进行临床检查 ,确定膝关节疼痛部位 ,检查膝关节活动度及稳定性 ,并利用膝关节屈曲90°的侧位X线片测量髌韧带长度。结果随访18例患者 ,17例术后膝关节存在触发性或功能性疼痛 ,膝关节疼痛常位于髌股关节、髌骨下极、髌韧带供区及胫骨结节部位。8例患者术后患膝活动度有不同程度受限。6例患者髌韧带发生不同程度的短缩 ,平均短缩2.8mm。4例患者髌股关节间隙变窄。两种术式以上并发症的发生率及严重程度差异无显著性意义。结论应用自体中1/3髌韧带重建前十字韧带不仅应注意疼痛等并发症的发生 ,还应关注髌韧带供区及髌股关节并发症的发生 ,重视其发病的病理基础。髌韧带中1/3缺损可引起髌韧带短缩及髌股关节退变。

Reconstruction of anterior cruciate ligament using autogenous midthird patellar tendon

Objective To explore relative complications and pathogenesis in the knee after reconstruction of anterior cruciate ligament(ACL) using autogenous midthird patellar tendon. Methods Reconstruction of anterior cruciate ligament with autogenous midthird patellar tendon was performed in 18 patients between January 1994 and November 1997. The surgical intervention included arthroscopic reconstruction(n=7) and miniarthrotomy (n=11). Results Eighteen patients were followed up for an average of 2 years.Ten patients had tenderness points in the donor site of the midthird patellar tendon, patellofemoral joint, apex of the patella and tibial tuberosity. Eight patients had lost of movement of a certain degrees. In 6 patients, the radiographs showed an average patellar tendon shortening of 2.8 mm, and in 4 patients narrowing of the joint line was found. There is no significant difference in complication between the two operative methods. Conclusion ACL construction using the midthird patellar tendon, had the disadvantages of morbidity problems at the patellar tendon donor site and the patellofemoral joint. The defect of the midthird patellar tendon can lead to patellar tendon shortening and degeneration of the patellofemoral joint.