关节镜下可吸收空心界面螺钉固定、四股腘绳肌腱重建前交叉韧带

Arthroscopic absorbable interference screw fixation and four-stranded hamstring tendons autograft for anterior cruciate ligament reconstruction

目的探讨关节镜下可吸收空心界面螺钉固定、四股自体绳肌肌腱重建前交叉韧带(anteriorcruciateligament,ACL)的方法及疗效。方法关节镜下以四股自体绳肌肌腱作为ACL替代物,应用(96L-4D)SR-PLA聚丙交酯生物可降解界面螺钉进行移植物固定,对42例ACL损伤行ACL重建术。结果42例术后随访3～22个月,平均114月,膝关节活动度均在正常范围。术后Lachman试验37例≤1+,4例2+,1例3+。轴移试验42例均为阴性。术后Lysholm评分(897±96)分较术前(494±91)分显著提高(t=212,P=0038)。术后Tegner活动评分(53±11)分较术前(23±07)分显著提高(t=413,P=0008)。术后1年MRI示29例可吸收空心界面螺钉部分被吸收;27例重建的韧带位置良好、形态正常;2例韧带在股骨的止点偏前;3例胫骨止点偏前,有轻度顶撞击现象。结论四股绳肌腱是ACL重建的理想替代材料,可吸收空心界面螺钉是ACL重建的理想内固定材料。

Objective To explore surgical techniques and clinical effects of arthroscopic absorbable interference screw fixation and four-stranded hamstring tendon autograft for the reconstruction of anterior cruciate ligament (ACL). Methods Forty-two patients with rupture of the ACL were operated on by arthroscopic four-stranded hamstring tendons autograft reconstruction using SR-PLLA absorbable screw fixation. Results Follow-up for 3～22 months (mean, 11 4 months) in all 42 patients showed normal motion range of knee joint. Postoperative Lachman test revealed ≤1+ in 37 patients, 2+ in 4 patients and 3+ in 1 patient. All patients showed an absent pivot shift. Postoperative Lysholm score was 89 7±9 6 points, which had increased significantly as compared with the preoperative score (49 4±9 1 points; t =2 12, P =0 038). Postoperative Tegner activity grading scale was 5 3±1 1 points, which was significantly higher than the preoperative one (2 3±0 7 points; t =4 13, P =0 008). MRI examination at first postoperative year showed that absorbable interference screws were partly absorbed in 29 patients,and reconstructed ligaments were in good position and normal in shape in 27 patients.The tendon grafts were anchored on the femur a little too more to the front side in 2 patients, and on the tibia a little too more to the front side in 3 patients, with slight impingement phenomena. Conclusions In ACL reconstruction, four-stranded hamstring tendon is an ideal graft material and absorbable interference screw is optimal for internal fixation.