保留胫骨止点的腘绳肌腱移植重建膝交叉韧带

目的 研究保留胫骨止点的自体腘绳肌肌腱移植重建交叉韧带的优缺点。方法 自2001年7月至2005年3月间我院收治交叉韧带断裂患者33例，前交叉韧带断裂17例，后交叉韧带断裂10例，前后交叉韧带断裂并外侧副韧带断裂3例，前后交叉韧带并内侧副韧带断裂3例。其中男性28例，女性5例。平均年龄28．2岁（18-45岁）。平均随访时间3．9年（范围0．5～5年）。使用特制取腱器将半腱肌腱和股薄肌腱从肌腹中抽出，回折锁边缝合成四股，穿过胫骨和股骨隧道。远端经过骨孔以界面钉固定或经过骨桥固定。结果 按照JOA膝关节韧带损伤疗效判定标准，手术前后评分分别为46．0分和79．8分，Lysholm膝关节评分标准手术前后分别为54．4分和80．3分（P〈0．001）。胫骨前移：术前平均10．9mm（范围9～13mm），术后平均3．6mm（范围0～7mm）（P〈0．001）。结论 保留胫骨止点的腘绳肌肌腱移植，可以适用于前后交叉韧带重建，其优点是取材方便，并发症少，胫骨隧道不再需要内固定。

Hamstring Autograft ACL Reconstruction with the Hamstring Insertion on Tibia Preserved

Objective To study the characters of tibia insertion preserved hamstring autograft to reconstuct the Cruciate ligament.Methods From Jul.2001 to Apr.2005.33 cases of cruciate ligament rupture are treated with this methods,of them,17 cases of ACL rupture,10 of PCL,3 of ACL,PCL and MAL rupture,3 of ACL,PCL and LAL rupture.28 male and 5 female patients.They are 28.2 years old average(from 18 to 45 years).The semitendin and gracilis tendon are harvested while their tibial insertion preserved with a special instrument.The tendonsis clear of muscle and turn back to form alop,with Krokow suture.Whin the tendon were pass through the tunnel in tibial,no internal fixation is needed,and in femurtunnel,they can be fixed with interface screw or through bone bridge.Results The JOA knee score is improved from 46.0 to 79.8 points(P<0.001).The Lysholm score is changed from 54.4 to 80.3 paints(P<0.001).Conclusion Autograft of hamatring with their tibial insertion preserved to reconstruct knee cruciate ligament is easy and reliable,needs not the tibial tunnel fixation divice.