关节镜下保留残端双股双隧道后交叉韧带重建术

目的评价关节镜下保留残端双股双隧道建后交叉韧带（PCL）的临床疗效。方法2007年6月至2010年6月，采用单束重建法重建后交叉韧带15例，男11例，女4例；年龄19～44岁，平均31．2岁；右膝7例，左膝8例。前外侧束定位于距上顶点12cm，距关节软骨7～8mm。屈膝70°前抽屉拉紧并固定。对18例PCL患者行保留残端双股双隧道重建，其中男15例，女3例；年龄18～56岁，平均33．4岁；右膝10例，左膝8例。股骨双隧道位于PCL原附着区，前外侧束定位距上顶点12cm，关节软骨7～8mm；后内侧束采用临近法定位于PCL印记内，前外、后内骨隧道内口骨壁2mm。术中保留PCL胫骨止点残端纤维及周围滑膜组织，移植物采用自体股薄肌和半腱肌肌腱。屈膝70°前抽屉拉紧并固定前外侧束，伸直位固定后内侧束移植物。结果全部病例得到随访，采用单束单隧道重建15例患者随访32．6（42—24）个月；采用双束股骨双隧道重建法的18例患者平均随访30．4（39～24）个月。两组Lysholm评分术前、术后差异有统计学意义（P〈0．05）。单束重建组与双束股骨双隧道重建组随访时的Lysholm评分分别为（91．4±3．6）分和（93．3±2．8）分，两组间差异无统计学意义（P〉0．05）。屈膝0°、60°时，单束重建组的胫骨后移距离是（5．8±0．4）和（5．2±0．6），双束股骨双隧道重建组是（3．4±0．3）和（3．9±0．5），两组间差异有统计学意义（P〈0．05）；屈膝90°时，两组胫骨后移距离差异无统计学意义（P〉0．05）。结论双股双隧道重建后交叉韧带符合解剖重建，较单束重建可获得更好的临床结果。

Arthroscopic double-bundle reconstruction of posterior crueiate ligament with double-femur-tunnel and remnant preservation

Objective To evaluate the clinical efficacy of arthroscopic double-bundle reconstruction of posterior cruciate ligament with double-femur-tibia-tunnel and remnant preservation. Methods From June 2007 to June 2010,15 patients were treated with single-femur-tibia-tunnel reconstruction and 18 patients were treated with double-femur-tibia-tunnel PCL reconstruction with remnant preservation under arthroscopy. The two femoral tunnels were placed on footprint, anterolateral bundle was centered at 12mm from the upper apex of femur condyle and 7mm from the remote articular cartilage, while posteromedial bundle was centered in the footprint according to the adjacent method. Residual PCL and surrounding synovial tissue was saved during the procedure. Hamstring tendon was used as autograft. The AL bundle was tightened and fixed in 70° degree of flexion, and PM bundle was tightened and fixed in 0° degree. Results All the patients were followed up. Average follow-up was 32.6 （42 - 24） months in the single tunnel group and 30.4 （39 - 24） months in the double tunnel group. All the patients showed negative PDT. The Lysholm score was （91.4±3.6） and （93.3 ±2.8） in the single and the double tunnel groups, with no statistical significance between the two groups （P〉0.05）. Measured by KT-1000 arthrometer, the posterior tibial translation was （5.8±0.4） and （5.2±0.6）mm in the single tunnel group at 0° and 60° flexion, while it was （3.4±0.3） and （3.9±0.5）mm in the double tunnel group, with a statistical significance （P〈0.05）. At 90° flexion, however, no significance was found between the two groups （P〉0.05）. Conclusions PCL reconstruction with double-femur-tibia-tunnel method is in consistent with anatomy. It has a better clinical efficacy than the single-femur-tibia-tunnel method.