嵌压固定法重建前交叉韧带不同肌腱移植物的选择

目的]探讨嵌压固定法重建前交叉韧带(ACL)不同肌腱移植物的选择。方法]采用嵌压固定法重建前交叉韧带101例,男68例,女33例。运动伤62例,交通伤22例,生活伤17例。采用绳肌腱结42例、骨栓绳肌腱结32例、带髌骨块的股四头肌腱27例。选用自体半腱肌腱和股薄肌腱,两端编织缝合预张力后在双股肌腱中间打结。将绳肌腱结内嵌入5 mm×11 mm的矩形骨栓,制成直径11 mm的骨栓肌腱结;带髌骨块的股四头肌腱全长70~80 mm,骨块11 mm×9 mm×7 mm。采用阶梯状联合钻建立股骨隧道,根据患者个体情况不同,选用自体绳肌腱结、骨栓绳肌腱结或带髌骨块的股四头肌腱,进行嵌压固定法重建ACL。将肌腱结或带髌骨块的股四头肌腱完全嵌入到瓶颈状股骨隧道内,在胫骨隧道外口分两股穿出,交叉打结固定在胫骨桥上。结果]98例患者得到随访,膝关节稳定,功能恢复良好。按照膝关节疗效评定标准,优88例,良6例,可4例,优良率85.7%。结论]根据患者个体情况选择绳肌腱结、骨栓肌腱结或带髌骨块的股四头肌腱,进行嵌压固定法重建ACL,生物固定、方法简便、固定可靠、创伤小、费用低。

Press fit technique reconstruction of anterior cruciate ligament with different types of tendon transplants

Objective]To explore the clinical effects of selecting differents type of tendon transplants to reconstruct anterior cruciate ligament(ACL) using press fit technique.Method]A total of 101 cases of ACL injury were included in this study,62 cases were athletic injuries,22 cases were traffic injuries,and 17 cases were daily-life injuries.According to patient's condition using different types of tendon transplant in which hamstring-tendon-knot 42 cases,bone-bolt-hamstring tendon knot 32 cases,patella bone-quadriceps tendon 27 cases,the tendon-knot was completely fit-into the bottle-necked femoral tunnel,and the tibial tunnel were pulled ont and seperated into two bundles, then tie a knot to fix the tendons tightly onto the bone bridge.Result]In this group 98 patients were followed-up,According to the knee joint effective evaluate standard,88 were excellent,6 good and 4 fine.Excellent and good rate was 85.7%.Conclusion]According to patient's condition,different type of tendon transplant to reconstruct ACL by press fit technique should be selected carefully.It is an method of easy to manipulate,reliable fixation,minimized trauma,biological fixation,economical and free expensive implant technique.