采用异体腘绳肌腱Rigidfix交叉钉与Intrafix膨胀挤压螺钉重建前交叉韧带初步报道

ANTERIOR CRUCIAL LIGAMENT RECONSTRUCTION WITH ALLOGRAFT HAMSTRING FIXED BY RIGIDFIX AND INTRAFIX ANCHORAGES

目的探讨关节镜下采用可吸收Rigidfix交叉钉与Intrafix膨胀挤压螺钉固定异体腘绳肌腱移植、重建膝关节前交叉韧带(anterior cruciate ligament,ACL)的手术方法和近期疗效。方法2006年1月～12月,取低温冷冻异体腘绳肌腱作为ACL的替代物,关节镜下应用可吸收Rigidfix交叉钉与Intrafix膨胀挤压螺钉固定治疗ACL损伤21例。其中男13例,女8例;年龄18～53岁。损伤原因:交通伤7伤,运动损伤11例,其他原因3例。合并度内侧副韧带(medial collateral ligament,MCL)及半月板损伤10例,内外侧半月板同时损伤3例,外侧半月板损伤6例,单纯ACL损伤2例。受伤至手术时间为7d～3个月。手术前、后按照Lysholm膝关节评分标准进行评价。结果术后21例均获3～9个月随访,平均5.8个月。术后膝关节活动范围19例超过120°;1例合并MCL损伤术后3个月屈膝受限80°,二期行关节镜下松解术;1例因排斥反应关节肿胀、发热,行关节镜冲洗后缓解。术后21例前抽屉试验、轴移试验均阴性,Lanchman试验度阳性1例,其余为阴性。Lysholm评分从术前56.73±6.58分增加至术后88.14±7.02分,差异有统计学意义(P<0.01)。结论关节镜下采用可吸收Rigidfix交叉钉与Intrafix膨胀挤压螺钉固定异体腘绳肌腱重建膝关节,手术方法简便,固定确实可靠,患者创伤小;术后早期康复锻炼,能快速恢复功能。

Objective To explore an improved reconstruction of the anterior crucial ligament （ACL） with the allograft hamstring fixed by the Rigidfix and Intrafix anchorages and to evaluate its therapeutic effectiveness in a short term. Methods The ACL reconstruction was performed under the arthroscope on 21 patients＇ knees from Janaury 2006 to December 2006. There were 13 males and 8 females aged from 18 to 53 years. The injuries were caused by a traffic accident in 7 patients, a movement damage in 11, and other factors in 3. The medial collateral ligament （MCL） and the medial meniscus were injured in 10 patients, the medial meniscus and the lateral meniscus were injured in 3, the lateral meniscus was injured in 6, and only the ACI was injured in 2. The operations were performed 7 days to 3 months after the injuries. The graft used was the four-stranded allograft hamstring, which was fixed by the Rigidfix and Intrafix anchorages. The therapeutic effect was evaluated according to the Lysholm rating scale. Results The follow-up of all the 21 patients for 3-9 months （average, 5.8 months） revealed that the knees of 19 patients could move beyond 120° after operation. In 1 patient who had the MCL injury, the range of genuflex was limited to 80° at 3 months after operation, and so the operation of lysis was performed under the arthroscope again. In 1 patient, the rejection against the allograft was treated by the irrigating under the arthroscope but had little effect. The anterior drawer test and the pivot shift test were negative in the 21 patients. During the Lanchman test, 1 patient had a positive result （Degree I ）. The Lysholm scores were significantly increased from 56. 73 ±6.58 to 88.14±7.02 （P〈0. 01）. Conclusion The surgical approach to reconstruction of ACL with the four-stranded allograft hamstring fixed by the Rigidfix and Intrafix anchorages is feasible and safe. The resulting fixation is reliable. The patients can begin their postoperative rehabilitation exercise earlier and their movement function can be restored earlier.