关节镜下自体腓骨长肌腱重建膝关节后交叉韧带

Study on reconstruction of posterior cruciate ligament with autologous peroneus longus tendon under arthroscopy

目的探讨关节镜下自体腓骨长肌腱重建膝关节后交叉韧带(posterior cruciate ligament,PCL)的疗效。方法2016年1月—2018年12月,收治46例膝关节PCL损伤患者。男34例,女12例;年龄20~58岁,平均40.7岁。急性损伤43例,陈旧性损伤3例。术前前抽屉试验阳性4例、后抽屉试验及胫骨后沉征阳性46例,内翻应力试验阳性10例、外翻应力试验阳性6例;屈膝30°位拨号试验患健侧差值为(5.20±3.91)°;后向应力位胫骨后移距离(12.03±2.38)mm。膝关节Lysholm评分为(36.68±7.89)分,国际膝关节文献委员会(IKDC)评分为(33.58±5.97)分,踝关节美国矫形足踝协会(AOFAS)评分为(97.60±1.85)分。关节镜下采用自体腓骨长肌腱解剖重建PCL,合并的半月板损伤、后外侧复合体损伤及前交叉韧带损伤均根据损伤程度进行对应处理。结果术后切口均Ⅰ期愈合。40例患者获随访,随访时间12~26个月,平均16.0个月。末次随访时,膝关节Lysholm评分为(84.85±7.03)分、IKDC评分为(87.13±6.27)分,与术前比较差异均有统计学意义(t=−13.45,P=0.00;t=−39.12,P=0.00);踝关节AOFAS评分为(93.98±2.14)分,与术前比较差异无统计学意义(t=8.09,P=0.90)。后向应力位胫骨后移距离为(2.75±1.76)mm、屈膝30°位拨号试验患健侧差值为(1.75±2.09)°,与术前比较差异均有统计学意义(t=29.00,P=0.00;t=4.96,P=0.00)。后抽屉试验及胫骨后沉征阳性1例,阴性39例;前抽屉试验以及内、外翻应力试验均为阴性。结论关节镜下自体腓骨长肌腱重建PCL能显著改善膝关节稳定性和功能,临床疗效满意。

Objective To discuss the effectiveness of posterior cruciate ligament(PCL) reconstruction with autologous peroneus longus tendon under arthroscopy. Methods Between January 2016 and December 2018, 46 patients with PCL injuries were enrolled. There were 34 males and 12 females, with an average age of 40.7 years(range, 20-58 years). There were 43 cases of acute injury and 3 cases of old injury. The anterior drawer test and the posterior tibia sign were positive in 4 cases, the posterior drawer tests and the posterior tibia sign were positive in 46 cases, the varus stress tests were positive in 10 cases, and the valgus stress tests were positive in 6 cases. The difference of dial-test at 30° knee flexion between affected and healthy sides was(5.20±3.91)°. The tibia posterior displacement under posterior stress position was(12.03±2.38) mm. The Lysholm score of the knee joint was 36.68±7.89, the International Knee Documentation Committee(IKDC) score was 33.58±5.97, and the American Orthopaedic Foot and Ankle Association(AOFAS) score of the ankle joint was 97.60±1.85. PCL was reconstructed with autologous peroneus longus tendon under arthroscopy, and the combined meniscus injury, posterolateral complex injury, and anterior cruciate ligament injury were all treated according to the degree of injury. Results All incisions healed by first intention. Forty patients were followed up 12-26 months, with an average of 16.0 months. At last follow-up, the Lysholm score of the knee joint was 84.85±7.03,and the IKDC score was 87.13±6.27, which were significant different from preoperative ones(t=-13.45, P=0.00;t=-39.12, P=0.00);the AOFAS score of ankle joint was 93.98±2.14, which was not significant different from preoperative one(t=8.09, P=0.90). The tibia posterior displacement under posterior stress position was(2.75±1.76) mm and the difference of dial-test at 30° knee flexion between affected and healthy sides was(1.75±2.09)°, which were significant different from preoperative ones(t=29.00, P=0.00;t=4.96, P=0.00). The posterior drawer test and the posterior tibia sign were positive in 1 case and negative in 39 cases;the anterior drawer test and the varus and valgus stress tests were all negative. Conclusion Reconstruction of PCL with autologous peroneus longus tendon under arthroscopy can significantly improve the stability and function of the knee joint, with satisfactory clinical results.