关节镜下双骨道多股自体腘绳肌腱解剖重建前交叉韧带

Arthroscopically assisted anatomical reconstruction of the anterior cruciate ligament with double-bundle multistranded hamstring tendons

目的探讨关节镜下双骨道多股自体腘绳肌肌腱解剖重建前交叉韧带(ACL)的方法和疗效。方法31例ACL损伤患者,年龄18～45岁,平均27岁。在关节镜下应用两组骨道,用多股半腱肌腱在屈膝50°～60°位拉紧并固定重建前内侧束,用多股股薄肌腱在屈膝10°～15°位拉紧并固定重建后外侧束。结果31例患者术后进行3～13个月(平均5.2个月)随访,术后膝关节活动度均在正常范围。术后前抽屉试验和轴移试验均为阴性;Lachman试验:25例“-”,5例“1+”,1例“2+”。术后Lysholm评分为(88.7±9.4)分,较术前(47.4±9.6)分显著提高(t=3.14,P<0.01)。术后Tegner活动评分为(6.9±1.3)分,较术前(3.1±0.9)分显著提高(t=3.13,P<0.01)。结论双骨道多股自体腘绳肌腱重建ACL能够更好地恢复膝关节在不同伸屈角度的稳定性。

Objective To explore the surgical technique of double-bundle multistranded hamstring tendons for reeonstruetion of the anterior erueiate ligament （ACL） under arthroseopy. Methods There were 31 cases with mean age of 27 years （ 18-45 years） who underwent ACL reconstruction through the double-tunnel multistranded hamstring tendons under arthroseope. The anteromedial bundle was reconstructed with multistranded autograft semitendinosus tendon grafts, When the anteromedial bundle was tightend and fixed, the knee should be at a flexion range for 50°-60°. The posterolateral bundle was reconstructed with multistranded autograft gracilis tendon grafts, When the posterolateral bundle was tightend and fixed, the knee should be at a flexion range for 10°-15°. Results The motion range of knee joint of all cases was normal. The postoperative Lachman test was negative in 25 cases, “1 ＋ ” in five and “2 ＋ ”in one, All cases showed absent pivot shift test and anterior drawer test. The postoperative Lysholm score was （88.7 ± 9.4） points, which increased more significantly compared with the preoperative one （t =3.14,P 〈0.01 ）. The postoperative Tegner activity grading scale was （ 6.9 ± 1.3） points, which increased distinctly compared with the preoperative one （ t = 3. 13, P 〈 0.01 ）. Conclusion The procedure of double-tunnel multistranded hamstring tendons for reconstruction of ACL under arthroseopy can better improve the knee stability at different flexion ranges.