四隧道保留残端后十字韧带重建术的近期疗效

目的 探讨关节镜下采用胫骨斜对角位点四隧道保留残端后十字韧带(posterior cruciate ligment,PCL)重建术的近期临床疗效.方法 2006年6月至2008年6月施行四隧道保留残端PCL重建术21例,男15例,女6例;年龄18～40岁,平均28岁.胫骨双隧道位点在PCL原不规则四边形止点的斜对角处,内下点为后内侧柬,外上点为前外侧束;股骨双隧道位于PCL附着足印区,前外侧束位点在10:30(左)或1:30(右),后内侧束在8:30(左)或3:30(右).术中保留后十字韧带残端纤维,并同时治疗合并损伤.移植物采用深低温冷冻同种异体胫前肌腱,对折双束两端缝合,使用可吸收界面螺钉固定.结果 全部病例随访12～18个月,平均14个月.后抽屉试验(posterior drawer test,PDT)术前(++)不稳15例,(+++)不稳6例;术后(-)15例,(+)不稳5例,(++)不稳1例.IKDC评分术前平均(62.14±4.9)分,术后(93.95±3.6)分,差异有统计学意义(t=10.3,P<0.05).其中正常17例,接近正常3例,不正常1例.Lysholm评分由术前(52.33±4.9)分提高到术后(91.19±3.6)分,差异有统计学意义(t=11.6,P<0.05).结论 采用胫骨双隧道斜对角位点四隧道保留残端PCL重建术能更多地保留残端纤维,保留隧道间骨桥,符合解剖重建,稳定性良好.

Primary clinical results of four-bone-tunel posterior cruciate ligament reconstruction with tensioning of remnant ligament

Objective To investigate primary clinical results of the reconstruction of posterior cruci-ate ligament (PCL) under arthroscopy with four diagonally laid tunnels. Methods From June 2006 to June 2008, 21 patients were treated with PLC reconstruction under arthroscopy with four diagonally laid tunnels.There were 15 males and 6 females, with the mean age of 28 years (ranged, 18 to 40 years). Two tibial tun-nels were located at the diagonal angles: posteromedial bundle was on the inferomedial angle while the an-terolateral bundle was on the superiolateral angle. The two femoral tunnels were located on the footprint, an-terolateral bundle was on 10:30 (left) or 1:30 (right), while posteromedial bundle was on 8:30 (left) or 3:30 (right). Residual PCL fibers were saved during the operation. Injuries of the PCL were also treated in the same operation. Two bundles deep-freezed hippicus muscle tendon were folded in half and sutured together as allografts. Absorbable screws were used in grafts fixation. Results Average follow-up was 14 months 12-18 months). Fifteen patients showed PDT (++) and six shows (+++) preoperation, 15 cases showed PDT(-), 5 cases shows (+), 1 case showed (++) postoperation. IKDC changed from 62.14±4.9 to 93.95±3.6. 17 cases were normal, 3 cases were near normal and 1 case were abnormal. Lysholm score significantly increased from 52.33±4.9 to 91.19±3.6. Conclusion This four diagonal angle tunnel technique keeps more PCL fiber and better protects bone bridge between tunnels. Moreover, it is close to anatomic reconstruction. The clini-cal outcome proves to be satisfactory.