关节镜监视下股骨端横杆式固定重建膝前十字韧带

Reconstruction of anterior cruciate ligament by transplantation of autogenous hamstring and fixation with a crossbar(Transfix) at the femoral side under arthroscopy

目的介绍在关节镜监视下利用半腱及股薄肌腱重建膝关节前十字韧带的横杆式固定(Transfix)及其应用体会。方法对72例膝关节前十字韧带断裂患者取自体半腱及股薄肌腱作移植物,在关节镜下应用股骨端横杆、胫骨端界面螺钉固定进行前十字韧带重建,观察此固定方法的可靠性及近期术后疗效,以Lysholm评分评价手术前后膝关节功能。同时行半月板修补2例、部分切除31例、大部分切除8例,软骨损伤病灶修整16例,内侧副韧带修补15例,髌腱断裂修补1例。结果65例患者获随访,随访时间8￣36个月,平均20个月。关节活动度正常,8例患者查体有阳性结果,平均Lysholm评分由术前的(56±6.3)分提高到术后的(91±4.8)分,差异有统计学意义(P<0.01)。复查X线片见2例股骨及胫骨隧道均扩大,5例股骨隧道扩大,2例胫骨隧道近端扩大,未见关节间隙变窄。并发症:4例横杆打入不足,钉头外突,需再打入,2例于术后8及9个月出现横杆钉头突出;3例胫骨切口以下局部皮肤感觉麻木,经治疗后症状消失。结论应用腘绳肌腱股骨横杆式、胫骨界面挤压螺钉固定法重建膝关节前十字韧带的近期疗效佳,移植物固定可靠,手术操作简便。

Objective To introduce a new technique about reconstruction of anterior cruciate ligament（ACL） by transplantation of autogenous hamstring and fixation with a crossbar （Transfix Ⅱ ） under arthroscopy and explore its effect on short term. Methods 72 patients with ACL injury were treated with ACL reconstruction by transplantation of autogenous semitendinous and gracilis tendon, fixed by a crossbar in femur end and a bio-absorbable interface screw in tibial tunnel. 2 cases of meniscus neoplasty, 31 partial meniscectomy, 8 large partial meniscectomy, 16 cartilage trimming, and 15 medial collateral ligament neoplasty, as well as 1 patellar tendon neoplasty were performed simultaneously. Pre-and post-operative knee joint function and stability as well as X-ray photograph were evaluated according to the Lysholm scoring scale system. The reliability of the fixation and its short-term effect were analyzed. Results 65 patients were available for follow-up with the duration from 8 to 36 months. The function of knee joint improved greatly. 8 cases had positive finding in physical examination. The average pre- and post-operative Lysholm score were 56±6.3 and 91±4.8, respectively （P〈0.01）. X-ray photograph showed femoral and tibial tunnel spread in 2 cases, femoral tunnel spread in 5, tibial tunnel spread in 2. The complications as outpocketing of the crossbar head occurred in 4 cases, which needed re-impaction, and dermal sensory numbness around in- cisions happened in 3 cases. Conclusion The short-term effect of ACL reconstruction is good through the method of autogenous hamstring and femoral crossbar （Transfix 11 ） fixation with tibial interface compression screw under arthroscopy. Not only the transplantation fixing was stable, but also the operation was accessible.