腘绳肌腱移植单隧道双束保残重建前交叉韧带的疗效

目的:探讨腘绳肌腱单隧道双束保残重建前交叉韧带(ACL)的可行性及近期疗效。方法:自2011年8月至12月采用关节镜下腘绳肌腱单隧道双束保残重建ACL25例,其中男19例,女6例;年龄16～50岁,平均(26.26±9.53)岁;左侧15例,右侧10例;病程1～60d,平均9.6d;新鲜损伤20例,陈旧性损伤5例。新鲜损伤患者均有膝关节肿胀、疼痛,其中前抽屉试验阳性14例,Lachman试验阳性17例。5例陈旧性损伤膝关节疼痛,均有关节不稳,前抽屉试验及Lachman试验均阳性。采用膝关节镜髌腱入路保留ACL残端,前内侧入路(AM)建立股骨隧道,胫骨端用点对点ACL瞄准器建立隧道。隧道股骨端采用Femoral-Intrafix固定,将腘绳肌腱分为前内侧束及后外侧束。通过旋转胫骨端移植物,将移植物调整为生理的双束位置,采用Bio-Intrafix和staple固定胫骨端。所有患者术前及术后分别行前抽屉试验和Lachman试验,并采用Lysholm膝关节功能评分评价膝关节功能。结果:25例均获随访,时间12～18个月。根据Lysholm膝关节功能评分:术前25～49分,平均34.08±7.60;术后12个月89～98分,平均94.52±2.86(t=21.29,P<0.01)。术后评分高于术前。结论:腘绳肌腱单隧道双束保残重建ACL,手术操作简便,固定牢固,效果可靠。

Intrafix fixation and remnants preservation in single-tunnel double-bundle reconstruction of anterior cruciate ligament with anatomical placement of hamstring tendons

Objective: To study the feasibility and short-term effects of Intrafix fixation and remnants preservation in single-tunnel double-bundle reconstruction of anterior cruciate ligament(ACL) with anatomical placement of hamstring tendons. Methods: From August 2011 to November 2011,25 patients with ACL injuries were treated with arthroscopic reconstruction of ACL using hamstring tendon. There were 19 males and 6 females,with a mean age of (26.26 ± 9.53) years (ranged,16 to 50 years). Fifteen patients had injuries in left knees,and 10 patients had injuries in right knees. The duration of the disease ranged from 1 to 60 d,with a mean of 9.6 d. All patients with acute injuries had swelling and pain on the knee,and anterior drawer test showed positive results in 14 cases,Lachman test showed positive results in 17 cases. Among patients with old injuries,5 patients had knee joint pain,5 patients had unstability of knee joint,5 patients had positive results of anterior drawer test,and 5 patients had positive results of Lachman test. The diagnosis of ACL injury was determined by the anterior drawer test and Lachman test. There were 20 patients with acute injuries and 5 patients with old injuries. MRI was performed in all patients to confirm the diagnosis of ACL injuries and provide additional information on meniscal and other ligament injuries. Preservation of the remnants was through patellar tendon portal using meniscus suture guide. The femoral tunnel was placed at lateral femoral condyle at 2:00 or 10:00 position through the anteromedial(AM) portal with the knee flexed to 120 degree using an offset guide(DePuy Mitek). The tibia tunnel was placed at the center of the ACL remnant through the AM portal using a tibia guide set 45 degree. The AM and PL bundles were rotated by rotating the positioning tool to achieve the desired positions of the bundles and were fixed by femoral Intrafix and tibia Bio-Intrafix fixation. The anterior drawer test,Lachman test and Lysholm scores were observed to determinate the function of the knee and the activity of the patients. Results: All the patients were followed up,and the duration ranged from 12 to 18 months. The Lysholm scores improved from preoperative 34.08±7.60(25 to 49 scores) to 94.52±2.86 (89 to 98 scores) at the follow-up time (t=21.29,P<0.01). No postoperative complications such as synovitis,ligament rupture and movement restriction occurred. Conclusion: Intrafix fixation and remnants preservation in single-tunnel double-bundle reconstruction of ACL with anatomical placement of hamstring tendons is simple,effective,useful,reproducible,and gives a satisfactory short-term results.