关节镜下自体四股腘绳肌腱可吸收界面螺钉重建前交叉韧带

Arthroscopic Reconstruction of Anterior Cruciate Ligament with Four Stranded Hamstring Tendon Autograft and Absorbable Interference Screw Fixation

目的探讨自体四股绳肌腱、可吸收界面螺钉重建前交叉韧带(anteriorcruciateligament,ACL)的手术方法及疗效。方法关节镜下以自体四股绳肌腱为ACL重建替代物,保留少许ACL残端作为定位标志物,应用可吸收界面螺钉固定,对37例ACL损伤病例行重建术。结果随访6～28个月,平均11.4个月。术后36例膝关节活动度在正常范围,无韧带撞击现象。Lachman试验:33例≤1+,4例2+。轴移试验术后全部阴性。Lysholm评分由术前的平均50.1分提高到术后的平均90.5分,差异有显著性意义(P<0.05)。结论关节镜下自体四股绳肌腱、可吸收界面螺钉重建ACL是恢复膝关节稳定性较好的方法。准确的关节内入口定位是手术成功的关键。

Objective To explore the surgical techniques and treatment result of arthroscopic reconstruction of anterior cruciate ligament （ACL） with four- stranded hamstring tendon autograft and absorbable interference screw fixation. Methods The arthroscopic reconstruction was performed on 37 cases of ACL injury with the SR - PLLA absorbable screw fixation and with the four- stranded hamstring tendon as the substitute and the residual ACL as the orientation marker. Results Followed - up time was ranging from 6 to 28 months （average： 11.4 months ） in all 37 patients, The results showed normal motion range of knee joint without ligament impingement. The postoperative Lachman test revealed 41 ＋ in 33 cases and 2 ＋ in four cases. The postoperative pivot shift test was negative in all cases. Lysholm score was increased to 90.5 ＋ 9.7 points after the operation from the preoperative score （50.1 ＋ 9.2 ） points with significant difference （t = 2.14 P = 0. 031 ）. Conclusion The arthroscopic reconstruction of anterior cruciate ligament （ACL） with four- stranded Hamstring tendon autograft and absorbable interference screw fixation is a good operation for restoring the stability of the knee joints. The accurate orientation of the intra- articular entry is the key of success for the operation.