前内侧入路解剖重建单束前交叉韧带的临床评估

目的评估关节镜下经前内侧入路解剖重建单束前交叉韧带(ACL)的位置、形态及临床效果。方法对25例ACL断裂患者在关节镜下经前内侧入路应用解剖重建技术行单束ACL重建术,移植物应用自体腘绳肌腱。术后行X线、MRI检查,了解骨道情况,观察移植物形态及张力,并与11例健侧膝关节的正常ACL进行对比。应用Lysholm评分系统评估膝关节功能。结果术后X线片显示股骨隧道内口位于髁间窝顶与股骨后缘皮质线交叉点前缘,胫骨隧道内口位于髁间窝顶后方。MRI显示所有重建ACL张力良好,ACL上倾角为50.82°±4.57°,胫骨平台止点至前缘距离与平台纵径比值为0.50±0.04,两项与对照组比较差异均无统计学意义(P0.05)。患者均获得随访,时间为13~44个月。Lysholm评分术后为92.20分±4.29分,明显高于术前的64.76分±7.16分(P0.01)。结论关节镜下经前内侧入路解剖重建ACL的位置及形态接近解剖结构,早中期临床效果满意。

Clinical outcomes in the single-bundle anterior cruciate ligament reconstruction using antero-medial portal technique

Objective To assess the position and clinical outcomes of the reconstructed single-bundle anterior cruci-ate ligament ( ACL) through anteromedial portal ( AMP) techniques .Methods Arthroscopic single-bundle ACL re-construction with autologous hamstring tendon was performed using AMP technique in 25 patients.The bone tunnel position, upward angle , tension of graft were measured from magnetic resonance imaging examination and plain radio-graphs ,11 healthy subjects were used as a control group .The clinical outcome was assessed by the Lysholm knee score.Results The lateral radiographs demonstrate the femoral tunnels were anterior to the intersection of the inter -condylar roof and the femoral posterior cortex line , and the tibial tunnels were posterior to the slope of the intercondy-lar roof.The upward dip of ACL measured from MRI were 50.82°±4.57°.The center of the bibial tunnel was loca-ted 0.50 ±0.04 of the entire sagittal length of the tibial plateau from the anterior edge of the tibia ,compared with the control group about the two terms data , there was not significant difference ( P>0.05 ) .The follow-up period was 13~44 months.The Lysholm score increased from 64.76 ±7.16 points to 92.20 ±4.29 points (P<0.01).Con-clusions ACL reconstruction through anteromedial portal technique is closer to anatomy reconstruction , which pro-vides satisfactory radiological and early clinical outcomes .