关节镜下股四头肌腱-髌骨块重建后交叉韧带

目的探讨关节镜下利用股四头肌腱一髌骨块嵌入和可吸收螺钉挤压固定方法重建后交叉韧带（posterior curciate ligament，PCL）的效果。方法33例PCL损伤患者，术前膝关节功能Lysholm评分平均51．3（32—78）分，IKDC分级：C级27例，D级6例。先获取股四头肌腱移植物并进行修整和预牵引，再制作胫骨及股骨隧道，然后植入股四头肌腱，将与之连接的髌骨块用可吸收螺钉挤压固定。结果所有患者均获得随访，平均18（3—37）个月，无血管神经损伤及移植物失败等严重并发症。所有患者均无膝关节不稳定症状，除5例患者剧烈活动或长时间活动后关节疼痛、2例患者轻微活动时关节疼痛外，其余患者关节疼痛症状明显缓解。术后Lysholm评分平均87．7（76—100）分，显著高于术前（P〈0．01）；IKDC分级A级23例，B级10例，明显优于术前（P〈0．01）。结论采用股四头肌腱移植物对取材部位无不良影响，移植物生物力学特性更接近PCL，且可以切取任意长度和宽度，保证远大于PCL的强度。移植物固定采用本文设计的骨块嵌入和可吸收螺钉挤压的方法，成功率高、并发症少，有明显优越性。

Arthroscopic Reconstruction of Posterior Cruciate Ligament with Quadriceps Tendon Fixed by A Patellar Block

Objective To discuss the clinical outcomes of arthroscopic reconstruction of posterior cruciate ligament（PCL） with quadriceps tendon fixed by a patellar block. Methods Thirty-three patients suffered from PCL injury were treated by the technique mentioned above. The preoperative Lysholm score was 51.3 （32 - 78 ） in average, and the IKDC grade was 27 of Grade C and 6 of Grade D. The connection between quadriceps tendon and superior patellar pole was harvested and pretreated. After the tibial tunnel and the fe- mur tunnel were prepared, the quadriceps tendon was put into the tunnels and was fixed by adsorbable screws. Results In the average follow-up period of 18 months, there was no severe nerve or blood vessel injury, nor failure of transplanted ligament, No patient complained of knee instability. The pain was relieved in 26 patients, except 7 complained of pain after the knee movement. The postoperative Lysholm score was 87.7（76 - 100）, and the IKDC grade was 23 of Grade A and 10 of Grade B, both was significantly different comparing with those of the pre-operation （P 〈 0.01 ）. Conlusions Quadriceps tendon with patelIar block can be harvested in enough length and width for PCL reconstruction with little influence to the donor area. The reconstructed quadriceps tendon is similar to PCL in biomechanic strength. So it is recommended with advantages of high success rate and few complications.