关节镜下六股自体腘绳肌肌腱胫骨双隧道重建膝前交叉韧带

Arthroscopic-assisted reconstruction of anterior cruciate ligament through twin tunnels in tibia by six bundles of autoallergic tendons

目的观察关节镜下六股“人”字形自体胭绳肌肌腱经胫骨双隧道重建膝前交叉韧带（anterior cruciate ligament，ACL）手术方法的可靠性和近期疗效。方法取自体股薄肌及半腱肌肌腱反折编织形成六股“人”字形移植物，采用关节镜下胫骨双隧道、股骨单隧道及界面螺钉固定方法行ACL重建手术32例；同时行半月板部分切除成形术17例，大部分切除术2例，修补术2例；软骨损伤病灶修整6例，内侧副韧带修补3例。其中30例患者获得随访，随访时间7～22个月，平均14个月。结果全部获随访者术后患膝关节活动度均正常，Lysholm评分由术前（62．0±4．5）分提高到（93．2±3．6）分（t=2．469，P〈0．01），KT-1000测定移动度为（1．3±0．4）mm；复查MRI显示胫骨骨隧道扩大2例，前内侧束髁间窝撞击4例。所有患者的X线平片未见明显关节间隙改变。结论关节镜下六股自体胭绳肌肌腱经胫骨双隧道、股骨单隧道及界面挤压螺钉固定方法重建ACL，其手术创伤少，并能最大限度恢复ACL的解剖重建，近期疗效佳。

Objective To introduce the operation methods of reconstructing anterior cruciate ligament through arthroscope by using six bundles of autoallergic tendons. Methods In 32 patients whose anterior cruciate ligaments were broken, the autoallergic tendons were woven to a flexional six-bundle graft before implantation. Twin tunnels in tibia were drilled, the tendon grafts were fixed by screws. All procedures were performed using a standard endoscopic technique, Partial meniscectomy was conducted in 17 patients, large partial meniscectomy in 2, meniscus prosthesis in 2, cartilage chipping in 6 And MCL prosthesis in 3. Results Thirty patients were followed up for 7 to 22 months （ 14 in average）. The Lysholm score improved from （62, 0 ± 4.5） to （93.2 ± 3.6） （ t = 2. 469, P 〈 0.01 ）. KT-1000 examination showed mean motion was （ 1,3 ± 0.4） mm. MRI callback showed 2 patients had various expanding of the tunnel in tibial tunnel, and 4 anteriomedialis bundle had a dash in fossa intercondylica. No narrowness in joint space was found on X ray film in all cases. Conclusion Using autoallergic tendons to weave into a flexional six bundles for transplants and twin tunnels in tibia by using screws pinning in the surfaces through arthroscope has less trauma, good joint stability, and better resumed anatomic construction. Its short-term therapeutic effect is excellent.