关节镜下缝线加强治疗后交叉韧带损伤

Arthroscopic augmentation of posterior cruciate ligament with suture fixation

目的介绍关节镜下缝线加强固定治疗后交叉韧带（PCL）损伤的方法，研究其临床效果。方法2005年10月至2006年6月，对13例单纯PCL损伤患者，在关节镜下采用缝线固定维持胫骨中立位，增加PCL的紧张度。采用IKDC和Lysholm膝关节功能评分表对患膝功能进行评估，通过KT-1000检查比较膝关节的后向松弛度。结果术后无伸膝受限，屈膝活动度120°～140°，平均128°。术后随访12～18个月（平均14．5个月），最后随访时IKDC评分；A6例，B7例；IKDC膝关节主观评分从术前的（67．4±3．3）分提高到随访结束时的（92．5±4．5）分，差异有统计学意义（t=9．837，P〈0．01）。屈膝90°位KT-1000检查，双侧胫骨结节后坠差异从术前的（8．1±1．7）mm减少到最后随访时的（2．0±1．3）mm，差异有统计学意义（t=12．230，P〈0．01）。陈旧性损伤患者术前Lysholm膝关节功能评分为（87．5±3．1）分，最后随访时为（95．8±3．5）分，差异有统计学意义（t=5．376，P〈0．01）。12例患者恢复了原来的运动水平，1例较损伤前稍有降低。结论在关节镜下采用缝线加强固定治疗急性PCL中远部损伤，能取得良好效果；治疗陈旧性PCL部分损伤，能够获得满意的结果。

Objective To investigate the outcome of augmentation of posterior cruciate ligament （PCL） using suture fixation technique. Methods Thirteen cases of simple PCL ruptures were treated arthroscopically with suture fixation to maintain tibial neutralization and augment PCL. The patients were followed up for 12 to 18 months. The IKDC and Lysholm knee score were used for function evaluation. The posterior knee laxity was examined by KT-1000. Results There was no limitation to knee extension. Knee flexion was between 120° and 140°, with an average of 128°. The final IKDC grade was A in 6 cases and B in 7 cases. The IKDC subjective score increased from preoperative 67.4 ± 3.3 to postoperative 92.5 ± 4. 5 （t=9. 837, P 〈 0. 01） . The average side-to-side difference in maximal manual test with KT-1000 arthrometer at 90° flexion decreased from 8.1± 1. 7 mm to 2. 0±1. 3 mm （t=12.230, P 〈0.01） . The Lysholm score in the 4 chronic cases was 87.5 ± 3. 1 before surgery and 95.8 ± 3.5 at the last follow-up （ t = 5. 376, P 〈 0.01 ）. Conclusion In some cases of PCL injury, excellent clinical results and good posterior stability can be achieved by augmentation of the torn PCL using suture fixation technique.