关节镜下腓骨长肌腱重建后交叉韧带的疗效观察

Efficacy of reconstruction of posterior cruciate ligament with peroneus longus tendon by arthroscopy

目的:探讨关节镜下采用腓骨长肌腱重建膝关节后交叉韧带(PCL)的临床疗效。方法:采用腓骨长肌腱在关节镜下治疗26例膝关节后交叉韧带断裂患者。其中男21例,女5例;年龄17~53岁,平均37.9岁;左膝9例,右膝17例。术前胫骨后沉试验、后抽屉试验和后向Lachman试验均为阳性,胫骨后移>10 mm。Ⅰ期手术24例,Ⅱ期手术2例。术前Lysholm评分为(17.15±1.29)分,IKDC2000评分为(31.04±1.46)分,Tegner运动能力评分为(1.85±1.01)分。合并半月板损伤5例,前交叉韧带断裂10例,侧副韧带断裂4例,其中合并腓总神经损伤4例。结果:术后患者切口均Ⅰ期愈合,无感染和血管神经损伤等相关并发症发生。患者均获随访,随访时间12~48个月,平均27.8个月。术后12个月,胫骨后沉试验、后抽屉试验和后向Lachman试验均为阴性,Lysholm评分为(83.38±3.73)分,IKDC2000评分为(85.70±1.41)分,Tegner运动能力评分为(5.88±0.99)分。与术前比较差异均有统计学意义(P<0.05)。结论:腓骨长肌腱在关节镜下重建膝关节后交叉韧带,创伤小,恢复快,并发症小,取腱安全容易,腱性部分长,临床疗效满意,是重建PCL的理想供体。

Objective： To investigate the effect of peroneus longus tendon reconstruction of the posterior cruciate ligament. Methods：Twenty-six patients after arthroscopic knee cruciate ligament rupture with the peroneus longus tendon were selected, including 21 males and 5 females; aged 17 to 53 years, with mean of 37.9 years; 9 cases of left knee, and right knee 17 cases. Cause of injury： traffic accident in 7 cases, falls injury in 9 cases, 10 cases of sports injuries. Preoperative tibial bone sink test, posterior drawer test and Lachman test were positive after tibial shift〉10 mm. And one-stage operation occurred in 24 cases, two-stage operation 2 cases. Preoperative Lysholm score was （17.15±1.29）, IKDC2000 score was （31.04±1.46）, and Tegner exercise capacity ratings were（1.85±1.01）. The combined meniscus injury was in 5 cases, 10 cases of anterior cruciate ligament, lateral collateral ligament rupture in 4 cases, and combined nerve injury in 4 cases. Results：All incisions were healed by first intention, and there was no nerve and vascular injury. All patients were followed up for 12 to 48 months with an average of 27.8 months. After 12 months, the posterior tibial sink test, posterior drawer test and Lachman test were negative, Lysholm score was （83.38±3.73）, IKDC2000 score was （85.70±1.41）, and Tegner exercise capacity rated （5.88±0.99）. Compared with preoperative cases, differences were statistically significant （P〈0.05）. Conclusion：Peroneus longus tendon in Arthroscopicre construction of posterior cruciate ligament of the knee, may be the ideal donor for reconstruction of the PCL due to quicker recovery，small complications and ideal clinical effect.