编制六股腘绳肌腱移植可吸收交叉钉固定关节镜下重建前交叉韧带临床分析

目的 总结关节镜下编制六股腘绳肌腱移植利用可吸收交叉钉固定重建前交叉韧带的方法,探讨其临床效果.方法 2005年3月至2008年6月,对39例前交叉韧带断裂患者在关节镜下采用自体腘绳肌腱六股编制移植重建前交叉韧带,移植物的股骨侧利用可吸收交叉钉固定.合并半月板损伤13例,行半月板缝合4例,部分切除8例,半月板全部切除2例;合并内侧副韧带Ⅲ度损伤4例,Ⅰ期行内侧副韧带修补或止点重建术;无合并后交叉韧带及后外侧角损伤患者.术后随访12～51个月,观察此固定方法的可靠性和术后疗效,以Lvscholm评分和KT-2000检查评价手术前后膝关节功能及稳定性.结果 32例患者获得随访,所有患者均无伸膝受限,膝关节屈膝活动度均>120°.屈膝90°时前抽屉试验均阴性;Lachman试验强阳性1例,阳性5例,阴性26例;膝关节功能Lyscholm评分为(92.6±4.2)分.KT-2000检查结果:31例为0～4.5 min,平均3.2 mm,1例患者关节不稳定,双膝差距6.5mm.结论 采用编制六股腘绳肌腱移植可吸收交叉钉固定关节镜下重建前交叉韧带,可以获得早期的初始稳定性和后期的生物稳定性,是一种可靠的手术方法,临床效果良好.

Arthroscopic reconstruction of anterior cruciate ligament with hamstring tendon graft using bioabsorbatble rigidfix cross pins

Objective To describe the surgical technique in reconstructing anterior cruciate ligament (ACL) with six strands harmstring tendon graft fixed by bioabsurbable rigidfix cross pins under arthroseopy and to e-valuate its efficacy. Methods From March 2005 to June 2008,39 patients with ACL injury were treated with ACL reconstruction by transplantation of six strands autogenous harmstring tendon , fixed by bioabsorbable rigidfix cross pins in femoral side. There are 22 male and 17 female,ages from 22 to 55 (the average age is 37). 19 cases were hurt in traffic accident, and another 20 cases in accidental injury. The state of illness is 7 days to 38 months. 13 cases merge the meniscus rupture, and 4 cases of meniscus suture,8 partial meniscectomy, 1 meniscectomy were performed simultaneously ;4 cases associating with the medial collateral ligaments Ⅲ degree injure underwent medial collateral ligament neo-plasty or reconstruction ;no cases merge posterior cruciate ligament injury, the patients were followed up 12 to 51 months , Pre-and post-operative knee joint function and stability were evaluated according to the Lysholm scoring scale system and the results of KT-2000 arthrometer , the clinical results and the reliability of the fixation were analyzed. Results 32 patients were followed-up and there is no limitation of the extention in the knee joints. The flexation of the knee joint is greater than 120°,and the anterior drawer test in 90° of flexation were negative in all patients. The postoperative Lachman test was strong positive in 1 case, negative in 26 cases and positive in 5 cases. The Lysholm scores was (92.6±4.2) points. The results of KT-2000 arthrometer: 31 cases 0-4.5 nun, average 3.2 mm;1 case 6. 5 mm. Conclusions It is a safe and reliable method to reconstruct ACL with six strands harmstring tendon graft fixing by bioabsorbable rigidfix cross pins under arthroscopy, and this procedure can obtain primary stabilization and long term stabilization of the autografts.