关节镜下同种异体髌韧带重建膝关节内韧带损伤的临床研究

Clinical Study of Arthroscopic Reconstruction of Intra-articular Ligament Injuried in Knee Joint Using Allogenous Patellar Tendons

目的探讨关节镜下异体髌韧带重建膝关节内韧带损伤的治疗效果。方法应用异体髌韧带重建膝关节内韧带损伤33例。其中单纯前交叉韧带损伤20例;单纯后交叉韧带损伤6例;同时损伤6例;部分损伤1例。结果本组全部得到随访。前抽屉试验阳性:术前27膝,术后2膝。后抽屉试验阳性:术前12膝,术后2膝。Lachman征阳性:术前26膝,术后2膝。全部患者主动屈曲达全范围为6～18周,平均12周。Lysholm评分单纯前交叉韧带组术前平均48.6分,术后89.5分,优良率95%。单纯后交叉韧带组术前平均35.8分,术后81.2分,优良率83%。前后交叉韧带组术前平均26.7分,术后69.1分,优良率83%。结论关节镜下异体髌韧带重建膝关节内损伤韧带是治疗膝关节内韧带损伤的有效方法。

Objective To invesigate the effect of application of bone - patellar ligament - bone allograft in reconstruction of cruciate ligament disruptions by arthroscopy. Methods From Jan. 2003 to Jan. 2006, there were 33 patients with cruciate ligament disruptions undergoing bone - patellar ligament - bone allograft reconstruction under arthroscopy. According to injury type, there were 20 patients with simple （ACL） injury,6 with simple （PCL） injury,6 with both ACL and PCL injuries and 1 with ACL part injury. All patients were treated by arthroscopic reconstruction using patellar ligament allograft. Results All patients were followed up. Physical examination showed that anterior drawer test positive： in 27 patients pre-operatively and 2 patients post- operatively; Posterior drawer test positive： in 12 patients pre-operatively and 2 patients post-operatively; Lachman sign： 26 patients pre- operatively and 2 patients post- operatively. All patients had the full range of flexion for 6 to 18 weeks, 12 weeks on average. The Lysholm scores of simple ACL injury group were 48.6 pre - operatively and 89. 5 post - operatively. The excellent and good rate was 95 %. The Lysholm score of simple PCL injury group were 35.8 pre- operatively and 81.2 post - operatively. The excellent and good rate was 83 %. The Lysholm scores of both ACL and PCL injuries group were 26.7 pre-operatively and 69.1 post-operatively. The excellent and good rate was 83%. Conclusion It is effective to reconstruct cruciate ligament disruptions of knee joint by arthroscopy with allogenous patellar tendons.