关节镜下股骨双束双隧道胫骨Inlay技术同种异体跟腱移植重建后交叉韧带

目的：探讨关节镜下同种异体跟腱重建后交叉韧带（PCL）的方法，验证股骨双柬双隧道、胫骨Inlay技术重建PCL的临床疗效。方法：2005年9月至2007年8月，采用经深低温冷冻及γ射线照射处理后的异体跟腱对10例PCL损伤的患者行关节镜下PCL重建术，手术方式股骨端为双束双隧道重建，可吸收挤压螺钉固定，胫骨端为Inlay固定。通过物理检查、Lysholm及IKDC评分来评价手术疗效。结果：术后8d内患者体温恢复正常，免疫排斥轻，无感染发生。所有患者术后获6～23个月（平均17个月）随访，终末随访时10例患者术膝胫骨下陷征（Sagsign）阴性，后抽屉试验（PDT）及Lachman征均为阴性或I度。疗效评定采用Lysholm评分和IKDC评分。Lysholm评分中交锁、不稳、疼痛、肿胀、爬楼、下蹲和总分术前术后比较差异有统计学意义，术后优7例，良2例，中1例；IKDC评分中疼痛频率、疼痛程度、规律活动量、活动影响程度、功能自评和总分等术前术后比较差异有统计学意义，术后IKDC评分A级7例，B级3例。结论：同种异体跟腱是重建PCL的可靠替代物，双束双隧道和Inlay技术固定可靠，可减少移植物损伤，是PCL重建的理想技术。

Arthroscopic posterior cruciate ligament reconstruction with Achilles allograft using transfemoral double-bundle and tibial inlay technique

Objcetive：To investigate and evaluate the results of arthroscopic posterior cruciate ligament （PCL） reconstruction with Achilles allograft using transfemoral double-bundle and tibial inlay technique. Methods：From September 2005 and August 2007,10 patients underwent arthroseopic PCL reconstruction with double-bundle Achilles allograft,whieh were deepfrozen and radiated by gamma ray. Two absorbable interference screw in the femur and tibial inlay technique were performed to fix the allograft. Clinical results were evaluated according to the physical examination ,Lysholm and IKDC clinical rating scales. Results ：The body temperature got to normal level 8 days after surgery. Immunologic rejection was detected but not serious and there were no infection found. All patients were followed up for 6 to 23 months （average 17 months）. At the last follow-up, there was no positive Sag sign, Lachman test and PDT were all negative or grade I positive. The average Lysholm score of the 10 cases was 39 （25-56） before operation, and 85 （79-92） at the last follow up, 41 （28 -62） before operation and 86 （81-90） at the last follow up for IKDC. Statistical differences existed before and after operation in the two Lysholm and IKDC scores. By Lysholm score, 90% patients got an exellent or a good result ; By IKDC score, all patients got an excellent or good result. Conclusion： This study has showed that PCL reconstruction with Achilles allograft using transfemoral double-bundle and tibial inlay technique is an effective method,