腘绳肌腱结嵌入固定结合双监视法解剖等长技术重建前交叉韧带

Clinical Application of Reconstruction of Anterior Cruciate Ligament with Guadruple Hamstring Tendons Knot Implant Fixation and Two-stakeout Anatomy Isometric Technique

目的探讨在关节镜下采用腘绳肌腱结嵌入固定结合双监视法解剖等长技术重建前交叉韧带(ACL)的可行性及近期疗效。方法对10例ACL损伤采用自体半腱肌、股薄肌腱中间打结,股骨端嵌入挤压固定法镜下重建ACL。半腱肌腱和股薄肌腱预张力后,肌腱中间打结,测量结与肌腱的直径,备用。用双监视法解剖等长技术,建立股骨胫骨端等长点,胫骨端用肌腱相同直径的钻头建立胫骨隧道。股骨端用自制的台阶样联合钻建立隧道。股骨隧道下30mm的直径为6～8mm,股骨隧道近端为11～12mm。将肌腱从股骨隧道的近端经关节腔牵入胫骨隧道,将肌腱拉紧、膝关节屈伸活动20次,使肌腱结完全嵌入瓶颈状股骨隧道内。将4股肌腱从胫骨隧道和其下方10mm处分别穿出,交叉打结并缝合固定在骨桥上。结果10例随访5～12个月,平均9个月。根据Lysholm膝关节功能评分,术前评分:20～45分,(29.80±12.79)分;术后半年评分:81～91分,(86.80±3.46)分(t=20.93,P<0.01)。结论腘绳肌腱结嵌入固定结合双监视法解剖等长技术重建ACL具有定位准确、手术操作简单、韧带等长重建、生物固定、不用内固定耗材、节约手术费用、疗效确切等优点,值得临床推广应用,尤其适用于广大部队伤病员。

Objective To study the feasibility and short- term effects of reconstruction of anterior cruciate ligament （ACL） with quadruple hamstring tendons knot implant fixation and two- stakeout anatomy isometric technique. Methods Arthroscopic ACL reconstruction was carried out in 10 patients with ACL injuries by using the quadruple hamstring tendons knot implant fixation and two - stakeout anatomy isometric technique. A knot was tied in the medial part of the tendons. According to two - stakeout anatomy isometric technique group, the bone tunnels of the femur and the tibia was prepared. The diameter of the tunnel 30mm inferior to the femur was 6-- 8 mm and superior to the spine 11 -- 12 mm.The tendon from the lateral side of femur tunnel was inserted into tibia tunnel followed by a knee bend in full extension and flexion for 20 times so that the tendon knots were absolutely inserted into the bottleneck - like femur tunnel. A hole was drilled 10 mm distal to tibia tunnel exit and 4 tendons were crossly knotted and fixed onto a bone bridge using curved clamps. Results Ten patients were followed up for 5 -- 12 months （mean 9 months）. The Lysholm scores improved from the preoperative score of 20-- 45 （29.80±12.79） to81--91 （86.80±3.46） at follow-up（t=20.93, P〈0.01）. Conclusion ACLreconstruction with quadruple hamstring tendons knot implant fixation and two - stakeout anatomy isometric technique has advantages in simple operation, anatomy isometric reconstruction, firm fixation, less expense and easy healing.