前入路关节镜下可吸收空心界面螺钉固定四股腘绳肌腱重建后交叉韧带

The arthroscopic absorbable interference screw fixation for four-stranded hamstring tendons autograft for reconstruction of the posterior cruciate ligament

目的探讨关节镜下生物可降解界面螺钉固定、四股自体腘绳肌肌腱重建后交叉韧带(PCL)的方法及疗效。方法关节镜下以四股自体腘绳肌腱作为PCL替代物,应用(96L4D)SRPLA聚丙交酯生物可降解界面螺钉进行移植物固定,对31例PCL损伤病人行PCL重建术。结果31例术后随访6～36个月(平均12.7个月),膝关节活动度均在正常范围。术后胫骨结节塌陷征和轴移试验均为阴性,Lachmen试验27例≤1+,3例2+,1例3+。术后Lysholm评分(90.7±7.4)分,较术前(54.3±8.1)分显著提高(t=2.32,P=0.027)。术后Tegner活动评分(5.9±1.2)分,较术前(1.9±0.7)分显著提高(t=3.43,P=0.008)。结论四股腘绳肌腱是PCL重建的一种理想替代材料,生物可降解界面螺钉是理想的内固定材料。

Objective: To explore surgical technique and clinical effect of arthroscopic absorbable interference screw fixation for four-stranded hamstring tendon autograft for the reconstruction of posterior cruciate ligament(PCL). Method: Thirty-one patients underwent PCL reconstruction with absorbable screw fixation for four-stranded hamstring tendon autograft under arthroscopy. The mean age was 23.5 years(16～43 years). Result: The mean follow-up period was 12.7 months (6 months～36 months). The motion range of knee joint of all cases was normal or nearly normal. The postoperative results of Lachman test was rated as ≤+ in 27 patients, 2+ in 3 patients and 3+ in 1 patient.Thirty-one patients also showed an absent pivot shift test and sag sign. The postoperative Lysholm score was (90.7±7.4) points, and the postoperative score increased significantly compared with the preoperative score (t=2.32, P=0.027). The postoperative Tegner activity grading scale was (5.9±1.2) points, and the postoperative grading scale increased significantly compared with the preoperative one (t=3.43, P=0.008). Conclusion: The arthroscopic PCL reconstruction using hamstring tendons and absorbable interference screw fixation have proved effective.