关节镜下股骨双隧道双束腘绳肌肌腱重建后十字韧带

Arthroscopic reconstruction of the posterior cruciate ligament with double-bundle hamstring tendons via double-tunnel in femoral

目的探讨关节镜下采用可吸收界面螺钉固定双束腘绳肌肌腱,股骨双隧道重建后十字韧带(PCL)的方法和疗效。方法24例PCL损伤患者,年龄为17￣42岁,平均32岁。在关节镜下应用可吸收界面螺钉固定,股骨双隧道胫骨单隧道双束腘绳肌肌腱重建PCL。3股半腱肌肌腱在屈膝15°￣30°位拉紧、固定,重建前外侧束;3股股薄肌肌腱在屈膝60°￣70°位拉紧、固定,重建后内侧束。结果24例患者术后随访6￣19个月,平均9.4个月。术后膝关节活动度均在正常范围,无疼痛,无创伤性关节炎。后抽屉试验、反向Lachman试验、胫骨结节塌陷征和反向轴移试验均为阴性,术后Lysholm评分为(92.7±6.4)分,较术前(49.4±9.3)分有显著提高(t=3.12,P<0.01)。术后Tegner活动评分为(6.7±1.4)分,较术前(3.2±0.9)分有显著提高(t=3.13,P<0.01)。结论股骨双隧道胫骨单隧道双束自体腘绳肌肌腱重建PCL能够较好的重建膝关节在不同伸屈角度的稳定性。生物可降解螺钉为PCL重建的理想的内固定材料。

Objective To research the surgical technique and curative effect of the posterior cruciate ligament （PCL） anatomical reconstruction with double-bundle hamstring tendons absorbable interference screw fixation via double-tunnel in femoral under arthroscopy. Methods 24 patients, average age of 32 years ranged from 17 to 42 years old, were treated with anatomical reconstruction of PCL through doubletunnel in femoral and one tunnel in tibia with double-bundle hamstring tendons fixed with absorbable interference screw under arthroscopic. The anterolateral bundle was reconstructed with multistranded autograft semitendinosus tendon grafts and was tightend and fixed, at knee flexion 15°-30°. The posteromedial bundle was reconstructed with muhistranded autograft gracilis tendon grafts, and was tightened and fixed, at knee flexion 60°-70°. Results All the patients were followed up for a mean time of 9.4 months （6 months-19 months）. All the knee joint motion were in normal range, no exhibition of pain and distinct trauma arthritis. The postoperative posterior drawer test, reverse Lachman test, tibia sags sign and reverse pivot shift test were all negative. The postoperative Lysholm score was （92.7±6.4） points, and the postoperative score increased significantly compared with the preoperative （t=3.12, P〈0.01）. The postoperative Tegner activity grading score was （6.7±1.4） points, increased greatly compared with the preoperative （t=3.13, P〈0.01）. Conclusion The procedure of double-tunnel with double-bundle muhistranded hamstring tendons for reconstruction of PCL under arthroscopy can recover the knee joint stability at different degree. Arthroscopic reconstruction of the posterior cruciate ligament with double-bundle hamstring tendons via double-tunnel in femoral and one tunnel in tibia can ideally recover the knee stability at different flection angle. Absorbable interference screw is an ideal internal fixation material for reconstruction of PCL.