关节镜下Moriya法重建膝前交叉韧带

Arthroscopic reconstruction of anterior cruciate ligament by Moriya’s method

目的报告关节镜下应用Moriya(守屋)法重建膝前交叉韧带(ACL)的手术方法及临床疗效。方法切取股薄肌腱、远段髂胫束瓣,胫骨止点保留,以髂胫束瓣包裹股薄肌腱重建ACL。手术16例,男12例,女4例。术前Lachman试验、前抽屉试验皆为阳性,经关节镜证实ACL内、外侧束完全断裂。结果术后随访4～17个月,平均随访9个月。按照日本骨科学会(JOA)制定的膝关节韧带损伤疗效评定标准,≥90分10例;80～90分5例;≤80分1例,优良率为93.75%。结论该术式对膝关节伸屈肌腱无损伤,不残留术后膝前痛,取材方便,操作简单,为关节镜下重建ACL的优良方法。

Objective To report arthroscopic reconstruction of anterior cruciate ligament (ACL) with iliotibial tract autograft and gracilis tendon by Moriya s method and to evaluate its clinical results. Methods The iliotibial tract autograft of about one third length was dissected with the tibial attachment kept. Then the trimmed gracilis tendon was wrapped in the iliotibial tract to reconstruct ACL. 16 patients (12 males and 4 females) were treated in this way. The anterior drawer test and the Lachman s test were all positive before operation, indicating that anteromedial and posterolateral bundles of ACL were totally broken, which was proved by arthroscopy. Results All patients were followed up for 4 to 17 months (mean 9 months). According to the criteria for knee ligament function evaluation set up by Japanese Association of Orthopaedics( JOA) , 10 patients scored ≥ 90 points, 5 patients 80 to 90 points, and 1 patient ≤ 80 points.The excellent and good rate was 93.75% . Conclusion Iliotibial tract autograft transfer with gracilis tendon to reconstruct ACL under arthroscopy boasts convenience in harvesting grafts, simplicity in performance and excellent results, without evidence of damaging extension and flexion tendons of the knee or causing patellofemoral pain. [