关节镜下保留残端纤维的前交叉韧带单束解剖重建术

Arthroscopic single bundle anterior cruciate ligament anatomical reconstruction with remnant preservation

目的:探讨关节镜下保留残端纤维的前交叉韧带单束解剖重建术的方法及临床效果。方法:自2007年10月至2009年11月,对17例前交叉韧带断裂患者进行保留残端纤维的前交叉韧带单束解剖重建术。其中男10例,女7例;年龄28～62岁,平均39.3岁。致伤原因:交通事故9例,日常生活摔倒受伤6例,运动创伤2例。伤后至手术时间平均8.5d(2～14d)。采用国际膝关节文献委员会(IKDC)分级及Lysholm评分等评估患者手术疗效。结果:17例均获随访,时间24～39个月,平均29.5个月。所有患者未发现腘窝动脉、胫神经或腓总神经损伤等并发症。12例膝关节活动度达到正常;1例出现关节僵硬,术后6个月予以关节镜下松解,术后积极功能锻炼,术后膝关节屈曲20°缺失,伸直正常;3例有屈曲5°～10°缺失;1例有5°过伸受限。17例后抽屉试验和Lachman试验均阴性。17例IKDC评分均达到或接近正常。IKDC总评分16例正常,1例接近正常。末次随访时IKDC主观评分为94.3±5.1,Lysholm评分为94.7±3.1。结论:关节镜下保留残端纤维的前交叉韧带单束解剖重建术可获得良好的临床效果。

Objective ：To investigate the feasibility and clinical effects of single bundle anterior cruciate ligament anatom- ical reconstruction with remnant preservation. Methods： From October 2007 to November 2009,17 patients（ 10 male and 7 fe- male, ranging in age from 28 to 62 years, with an average of 39.3 years） with posterior cruciate ligament injuries were treated with single bundle anatomical reconstruction with remnant preservation. Nine patients had the injuries caused by traffic acci- dent; 6 patients caused by falling down;and 2 patients caused by sports injuries. The average time from injury to surgery was 8.5 days （ranging from 2 to 14 days）. The international knee documentation committee knee evaluation form （IKDC） and Lysholm were used to analysis the effect of surgery. Results： All the patients obtained the follow-up and the average time was 29.5 months （ranging from 24 to 39 months）. There were no complications such as injuries of popliteal fossa artery, tibial nerves or peroneal nerve. Twelve patients had knee joint recovering to normal; 1 patient had stiff joints and was treated with arthro- scopic surgery to release after 6 months, who had postoperative flexion lack of 20 degree and straight to normal. Three patients had flexion loss of 5 to 10 degree ,and 1 patient had hyperextension limitation of 5 degree. Posterior drawer test in 17 patients and the Lachman test were negative. IKDC scores of the 17 patients achieved normal （16 patients） or near normal （1 patient）. IKDC overall score normal in 16 patients （94.1%）, close to normal in 1 case （5.9%）. The IKDC subjective score was 94.3±5.1 and Lysholm score was 94.7±3.1 at the latest follow-up. Conclusion ：The single bundle anterior cruciate ligament with remnant preservation anatomical reconstruction can provide good clinical results.