自体骨-股四头肌腱重建后交叉韧带的临床应用

目的探讨关节镜下利用自体髌骨块-股四头肌腱植入和可吸收界面螺钉挤压固定方法重建后交叉韧带（PCL）的效果。方法 17例PCL损伤患者,术前膝关节功能Lysholm评分平均（64.5±5.8）分;IKDC分级：C级11例,D级6例。术中探查后切取股四头肌腱移植物进行修整,建立后外侧辅助通道,再制作胫骨与股骨隧道,然后植入股四头肌腱,两端隧道均用可吸收界面螺钉挤压固定。术后予膝关节角度锁定助行器辅助锻炼6-12周,3个月后恢复正常行走。结果所有患者均获随访,平均48（36-84）个月,无血管神经损伤及移植物失败等严重并发症。1例患者轻微活动时疼痛,2例患者剧烈活动或长时间行走后关节疼痛,1例患者偶感患膝不稳,均无伸膝受限,最后随访时膝关节主动屈曲活动度平均为132°（120°-140°）。术后Lysholm评分平均（89.5±5.6）分,明显高于术前（t=0.020,P〈0.01）;IKDC分级：A级10例（58.8%）,B级6例（35.2%）,C级1例（5.8%）。结论采用关节镜下改良技术行股四头肌腱重建PCL可以使手术更加顺利完成,成功率高,创伤小,并发症少,对供区无不良影响,临床取得满意的疗效。

Posterior cruciate ligament reconstruction with autologous bone-quadriceps tendon

Objective To discuss the clinical effect of the posterior cruciate ligament reconstruction with bone-quadriceps tendon implantation and absorbable screw by arthroscopy. Methods 17 patients were chosen, and the mean Lysholm score before operation was (64.5±5.8). IKDC grade was C in 11 patients and D in six patients. The quadriceps tendon was obtained, and a postlaterel tunnel and tibial-femoral tunnel were set up. Absorbable screws were used to fix the implanted tendon. After the operation, the walker was used to help exercise for three months. Results All the patients were followed up for about 48 months. There was no severe complications. Three patients had pain when walking, while one patient felt knee joint unstable., All patients had no extention limitation, and the mean ROM was 132° (120°-140°).The mean Lysholm score after operation was (89.5±5.6), which was significant different from the score before operation (t=0.020, P<0.01). As for IKDC grade, 10 cases were A (58.8%), six cases were B (35.2%), and one case was C (5.8%). Conclusions Quadriceps tendon reconstructing the PCL by arthroscopy can make the operation more smoothly, with less complications, little trauma, and higher achievement ratio. The clinical efficacy would be good.