关节镜下腓骨长肌腱单束重建前交叉韧带

Anterior cruciate ligament reconstruction with peroneus longus tendon under arthroscope

目的探讨关节镜下应用自体腓骨长肌腱(PLT)重建膝关节前交叉韧带(ACL)的临床疗效,并对供体区相关并发症进行分析。方法前瞻性分析唐山市第二医院关节外科2017年3月至2017年11月收治的45例前交叉韧带断裂患者的一般资料,将所有患者分成两组,其中腘绳肌腱组(23例)行关节镜下自体腘绳肌腱单束重建前交叉韧带,腓骨长肌腱组(22例)行关节镜下自体腓骨长肌腱单束重建前交叉韧带。所有患者术前Lachman试验、前抽屉试验阳性,MRI显示前交叉韧带断裂。记录手术前后患侧胫骨较健侧前移差值(SSD)及大腿周径变化;采用IKDC(国际膝关节文献委员会)评分、足踝残疾指数(FADI)评价膝、踝关节功能;术后行MRI检查评估肌腱走形。定量资料的比较采用t检验。结果45例患者术后均获随访,平均(17.3±1.4)个月,无关节粘连、韧带再断裂、严重下肢深静脉血栓等并发症。术中移植物编织后直径及长度腓骨长肌腱组大于腘绳肌腱组,差异有统计学意义(t=-2.544、-10.523,均为P<0.05)。至术后1年时,两组患者膝关节IKDC评分及活动度较术前有显著改善(腘绳肌腱组t=-61.610,腓骨长肌腱组t=-55.740,均为P<0.05),但两组间差异无统计学意义(均为P>0.05);两组患者踝关节FADI评分差异无统计学意义(P>0.05);腓骨长肌腱组大腿周径双侧差值小于腘绳肌腱组(t=12.420,P<0.05);MRI提示两组患者移植物走形良好,无髁尖窝撞击。结论关节镜下自体腓骨长肌腱重建前交叉韧带临床疗效确切,大腿肌肉萎缩程度较轻,且对踝关节功能无明显影响,值得临床推广。

Objective To investigate the clinical efficacy of arthroscopic reconstruction of anterior cruciate ligament(ACL)with peroneus longus tendon(PLT)and study the donor-related complications.Methods A retrospective study was conducted on 45 patients who had anterior cruciate ligament rupture and treated in the Department of Joint Surgery of the Second Hospital of Tangshan between March and November 2017.The patients were divided into a PLT group(n=23)and an HT group(n=22).The patients in PLT group received the reconstruction of anterior cruciate ligament under arthroscope with autograft peroneus longus tendon,and the patients in HT group received arthroscopic reconstruction of anterior cruciate ligament with hamstring tendon single bundle.Preoperative Lachman test and front drawer test were positive on all patients together with rupture of anterior cruciate ligament showing on MRI.Side-to-side difference(SSD)and thigh circumference were taken before and after surgery.Knee and ankle functions were assessed by International Knee Documentation Committee(IKDC)score and foot and ankle disability index(FADI).Postoperative MRI scans were taken for assessment of tendon running.Results All patients were included in postoperative follow-up for(17.3±1.4)months in average.No postoperative complication such as joint adhesion,ligament re-rupture or severe deep venous thrombosis of lower limb occurred.The diameter of PLT after graft weaving was found greater than that of HT,with statistically significant difference(t=-2.54,-10.523,both P<0.05).At 12 months after surgery,IKDC scores and activity of knee joint in two groups were remarkably improved in comparison with those before surgery(HT group t=-61.610 and PLT group t=-55.740,both P<0.05),and without statistically significant difference between the two groups(all P>0.05).There was no statistically significant difference in ankle FADI scores between the two groups(P>0.05).The bilateral difference of thigh circumference in the PLT group was smaller than that in the HT group(t=12.420,P<0.05).MRI indicated that the grafts were running well and without condylar fossa impingement in both groups.Conclusion Arthroscopic reconstruction of ACL with PLT autograft has good clinical effect,featuring less muscle atrophy of thigh and unaffected ankle function,which is worthy of clinical application.