关节镜下半腱肌腱和股薄肌腱双隧道重建前十字韧带

Arthroscopic reconstruction of double-bundle anterior cruciate ligament with semitendinosus and gracilis tendon

目的探讨关节镜下联合应用半腱肌腱和股薄肌腱重建前十字韧带(anteriorcruciateligament,ACL)的方法及疗效。方法回顾自1998年4月～2000年5月在关节镜下联合应用半腱肌腱和股薄肌腱重建ACL的患者12例。于ACL前内侧束和后外侧束的附着部分别钻直径4.5mm的隧道,用半腱肌腱重建前内侧束,股薄肌腱重建后外侧束,保留半腱肌腱和股薄肌腱的附着点,在股骨隧道外口将半腱肌腱和股薄肌腱打结固定,不行内固定。所有患者术前及术后18个月行膝关节屈曲30°、60°、90°前抽屉试验,Lysholm评分方法评定膝关节功能。结果术后随访18～43个月,平均26个月。术前所有患者前抽屉试验均为阳性,术后9例阴性,2例屈膝30°位阳性,1例屈膝30°、60°位阳性。术前Lysholm评分为40～58分,平均50.5分,手术后18个月为62～92分,平均85分,总优良率为91.7%。结论应用半腱肌腱和股薄肌腱联合重建ACL,术后膝关节动态稳定性好,疗效满意。

Objective The investigation was to evaluate the method and the efficacy of double-bun-dle anterior cruciate ligament reconstruction with semitendinosus and gracilis tendon through two bone tun-nels.Methods From April1998to May2000,12patients underwent double-bundle anterior cruciate liga-ment reconstruction were reviewed and followed up more than18months.There were12male and2female patients aging from17to38years old(mean,25.5years).5cases were associated with simple anterior cru-ciate ligament injury,and the other7cases suffered from anterior cruciate ligament injury with concomitant torn meniscus.Two bone tunnels of4.5mm diameter were made in the tibial and the femoral attachment site of ACL anteromedial bundle and posterolateral bundle respectively.The anteromedial bundle was recon-structed using semitendinosus tendon,and the posterolateral bundle was reconstructed using the gracilis ten-don.The attachments of the semitendinosus and gracilis tendon outside tibial tunnels were reserved,the re-paired tendons were tied as a knot outside femoral tunnels.There was not need to do any internal fixation.Anterior drawer test was performed in30,60and90degrees of flexion of the knee joint,and Lysholm rating system was used to determine the function of the knee and the level of activity of the patients.Results Be-fore operation,anterior drawer test in30,60and90degrees of flexion of the knee joint was positive in all patients,the mean Lysholm scores were50.5points(range,40to58points).18months after operation,ante-rior drawer test in30,60and90degrees was negative in9cases,anterior drawer test in60,90degrees of flexion of the knee joint was negative in2cases,in90degrees negative in1case;The mean Lysholm scores was85points(range,62to92points).The good and excellent results were obtained in91.7%.Conclusion The combination of double-bundle anterior cruciate ligament reconstruction makes a great progress to anatomic reconstruction,provides better dynamic stability of the knee joint,and predisposes the patients sat-isfactory clinical effects.