解剖重建腘腓韧带治疗膝关节后外旋转不稳定

Anatomical Popliteofibular Ligament Reconstruction for Treating Posterolateral Knee Instability

目的：介绍解剖重建胭腓韧带治疗膝关节后外旋转不稳定的手术技术与治疗效果。方法：自2003年7月～2006年9月，采用胭腓韧带重建手术治疗19例膝关节后外旋转不稳定患者。随访时间大于等于1年的病例占94．7％（18/19），平均随访期27．2个月。所有病例均为陈旧性损伤，且均为复合韧带损伤，包括后交叉韧带、前交叉韧带、内侧副韧带。全部病例的术前胫骨外旋与健侧相比均大干10°。所有患者手术前后均进行临床查体、X线片、MRI检查以及IKDC主、客观评分。手术方法为：通过膝关节外侧切口，在腓骨头胭腓韧带止点处制作双骨隧道，在股骨侧胭肌腱起点制作骨隧道，移植物选择自体半腱肌腱或异体胫前肌腱。移植物的两端穿过腓骨头骨隧道后，使用一枚可吸收挤压螺钉固定在股骨隧道内。同时对合并的其它韧带损伤进行修复或重建。结果：与健侧相比胫骨外旋角度减小0°～5°（不包括5°）者14例，减小5°～10°（不包括10°）者3例，减小10°～15°（不包括15°）者2例。屈膝受限平均4．2°（O°～10°）。无伸膝受限病例。术后IKDC评分为：A级7例，B级12例。术前所有病例均为D级。结论：胭腓韧带解剖重建技术是治疗单纯膝关节后外旋转不稳定的良好方法，手术安全，操作简单，可获得较满意的临床疗效。

Objective In this study, the technique of anatomic reconstruction of popliteofibular lig- ament （PFL） for treating posterolateral instability and its clinical outcome were presented. Methods From 2003 to 2006, 19 cases with posterolateral instability （type A） underwent popliteofibular liga- ment reconstruction with autograft semitendinosus or allograft anterior tibialis tendon. The fibular tunnel was made at the origin of PFL and then double limbs of the graft went through the tunnel. The both end of the graft was fixed with an absorbable interference screw at the PFL femoral origin, just 18.5mm infero-anterior to the femoral epicondyle. Results The cases of one year minimum follow- up were accounted for 94.7% （18/19） of the patients and average follow-up period was 27.2 months. Of the 19 patients, 12 were male and seven were female, aged 32.4 years. The injuries in all patients were chronic and complex, including injuries of posterior cruciate ligament and/or anterior cruciate ligament. As compared with the normal side, external rotation of tibial in all patients increased more than 10 degree before operation, and reduced to 5°-10° （side to side） after operation. According to the International Knee Documentation Committee （IKDC）, all patients were classified as D before operation, whereas 7 patients were classified as A and 12 were classified as B after operation. Conclusion The technique of anatomic reconstruction of PFL was effective surgical procedure and safe enough for patients to improve the stability of posterolateral corner injury （type A）.