关节镜下髌腱中1/3重建前交叉韧带手术取腱切口方向选择研究

Comparison of Transverse and Longitudinal Incisions for B-T-B Graft Harvesting in Reconstruction of Anterior Cruciate Ligament

目的:探讨关节镜下髌腱中1/3重建前交叉韧带手术中,横切口取腱和纵切口取腱的优缺点。方法:以2004年1月至2004年12月间行髌腱中1/3重建前交叉韧带手术病例64例为研究对象,其中横切口取腱32例,纵切口取腱32例,随访时间均超过1年。比较两种方法的手术时间、切口长度、疤痕面积、隐神经髌下支受损和膝关节功能恢复情况。结果:两种方向取腱患者膝关节活动度全部恢复正常,且二者之间无明显差异。横切口取腱手术平均时间较纵切口延长11分钟;横切口长度(5.0cm/m±0.25cm/m)显著短于纵切口(5.8cm/m±0.16cm/m),其疤痕面积(2.32cm2±1.75cm2)显著小于纵切口(7.05cm2±2.75cm2);横切口取腱患者无明显跪地痛表现;横切口取腱患者隐神经髌下支受损率为81.3%(26/32),而纵切口取腱患者为87.5%(28/32),二者无显著性差异。结论:关节镜下髌腱中1/3重建前交叉韧带,横切口取髌腱与纵切口相比,手术难度较大,但术后疤痕小。关节功能不因切口方向选择有任何影响。两种切口方向取腱,隐神经髌下支损伤发生率较高。

Objective To study the difference of transverse incision and longitudinal incision for B-T-B graft harvesting in reconstruction of anterior cruciate ligament. Methods Sixty four cases of reconstruction of anterior cruciate ligament from January 2004 to December 2004 were observed. Transverse incisions were used in 32 cases, and longitudinal incision were chosen in the other 32. The operation time, the length of incision, the thickness of scar, the injury of saphenous nerve and the joint function of knee were compared. Results All patients were followed up more than 1 year. The average duration of surgical procedure with longitudinal incision was 11 minutes shorter than that with transverse incision. The scar of transverse incision is smaller and thinner than that of longitudinal incision. The injury of saphenous nerve and knee joint function of knee revealed no notable difference in the 2 groups. Conclusions Transverse incision for B-T-B graft harvesting in reconstruction of anterior cruciate ligament is a better choice.