关节镜下运用LARS人工韧带重建膝前交叉韧带

Clinical report on arthroscopic reconstruction of anterior cruciate ligament with LARS artifical ligament

[目的]探讨在关节镜下运用“LARS人工韧带”重建膝前交叉韧带的手术方法和临床疗效。[方法]2006年6月起运用法国LARS膝关节前交叉韧带治疗急性前交叉韧带断裂15例，男11例，女4例，年龄22-51岁（平均26.8岁）。所有患者术前Arto-scan均提示前交叉韧带连续信号中断，膝关节Lysholm评分平均50分。治疗在关节镜下完成，股骨隧道口定位在外髁内侧面140°弓形弧的中心点，胫骨隧道口定位在平台内外侧髁间嵴之间、髁间窝顶线后2-4mm。骨隧道直径为7.5mm、LARS韧带直径为8mm、空心挤压螺钉直径为8mm。[结果]经平均18个月随访，术后Lysholm评分平均90分，优8例，良5例，可2例，近期优良率为86.6％。本组无术后感染、无韧带自发断裂、无韧带松动并发症。[结论]运用“LARS人工韧带”重建膝前交叉韧带可达到解剖重建，可有效恢复膝关节稳定性；关节镜下手术拥有创伤小、康复快、疗效好等微创特点。

[Objective] To explore the operating methods and rudimental clinical effects of reconstruction of anterior cruciate ligament （ACL） with the ligament advancement reinforcement system （LARS） artificial ligaments under arthroscope. [Method] Since June of 2006,15 patients （11 males and 4 females, with an average age of 26.8 years） with acute ACL rupture have been treated with the LARS artificial ligaments. The results of preoperative Arto-scan of all patients suggested discontinuation of ACL. The average score of Lysholm on knee joint was 50 points. The operations were completed under arthroscope. Bone tunnels of the femur were located at the central point of arc on the medial surface of ectocondyle of 140 degree. Bone tunnels of tibia were located between the medial and lateral condyle on the tibial plateau ,2-4mm to summit line of fossa intercondylica. The diameter of the bone tunnels was 7.5 mm while that of LARS ligament and hollow crushing screw were 8 mm. [Result] All 15 patients were available for follow-up with an average of 18 months. No postoperative complications such as infection, ligament rupture, ligament loosening occurred. The clinical results were graded as being excellent in 8 patients, good in 5 and fair in 2 according to the Ly-sholm＇s classification. The excellent and good rate was 86.6%. [Conclusion]The anatomical reconstruction and the stability of the knee joint can be obtained after ACL reconstruction with LARS artificial ligaments. The operation under arthroscope has advantages of less-injury, rapid recovery and satisfactory curative effect.