关节镜下同种异体肌腱双束法重建前交叉韧带

Dual beam allogenic tendon reconstruction of ACL under arthroscopy

目的探讨同种异体肌腱移植重建关节内韧带,双束韧带即前内束(AM)、后外束(PL)重建前交叉韧带(ACL),完善韧带修补重建的条件,以期达到ACL重建后膝关节的生物力下曲率运动的均衡和对膝关节回旋稳定的调控。方法对67例ACL患者应用同种异体肌腱重建ACL。股骨髁侧椭圆形隧道,应用Arthrax公司提供的横钉固定肌腱法固定;胫骨侧建立ACL-AM和ACL-PL双隧道,挤压钉固定。结果67例均获随访,时间12～36(18.4±3.8)个月,Lysholm评分:术前(34.47±1.5)分,术后3个月(78.35±3.4)分,术后6个月(81.88±3.3)分,术后12个月(87.76±2.1)分,术后18个月(89.70±3.5)分。有关节软骨损伤者,影响术后Lysholm评分。结论同种异体肌腱可以满足韧带受区的要求,双束ACL重建符合膝关节韧带4连杆曲率生物运动模式,膝关节回旋稳定度高。手术操作简单,效果良好。

Objective To study allogenic tendon transplantation to reconstruct interarticular ligament by dual beam ligament scilicet for anteromedial beam （AM） and posterolateral beam （PL） to re-establish anterior cruciate ligament （ACL）, to achieve the condition that can restore or re-establish the ligament with the power of vitodynamics articular genu curvature movement is equilibrate and when the joint is convolution it can stabilize it. Methods 67 cases were undergone ACL reconstruction using allogenie tendon. Through elliptic tunnel on the side of condyles of femur, using transversalis nail fix method that Arthrax company provided, and through double tunnel tibia to reconstruct ACL for AM and PL with crushing nail. Results 67 cases were followed-up for 12 -36 （ 18.4 ± 3.8 ） months. Before operation Lysholm score was 34.47 ± 1.5, after operation 3 months it was 78.35 ± 3.4, 6 months it was 81.88 ± 3.3, 12 months it was 87. 76 ± 2. 1, 18 months it was 89. 70 ± 3.5. These cases that have arthrodial cartilage injury influence the Lysholm score of after operation. Conclusions Altogenic tendon can achieve the requirement of ligament recipient site, dual beam ACL re-establish consistent with 4 connecting rod curvature biologic motor pattern of ligament of knee joint, gyratus stability is good. Operative procedure is simple, and effect is good.