关节镜下同种异体腘绳肌腱移植重建前交叉韧带11例

Arthroscopic reconstruction of anterior cruciate ligament using hamstring tendon transplantation in 11 cases

2006-08/2007-12梅河口市市医院骨科采用解放军第三○四医院组织库提供的超低温冷藏同种异体半腱肌和股薄肌肌腱作为膝关节前交叉韧带的移植替代物,对11例膝关节前交叉韧带损伤患者进行了关节镜下前交叉韧带重建。选用同种异体半腱肌和股薄肌肌腱,用16万U庆大霉素的250mL等渗盐水中浸泡30min,修整编织,测量肌腱直径,根据其直径确定骨隧道直径备用。用与肌腱直径相同的钻头建立胫骨及股骨隧道,将异体肌腱植入胫骨及股骨隧道,股骨端用RIGIDfix固定,将异体肌腱拉紧,于0°～120°牵拉韧带下屈伸膝关节20次后,拉紧韧带,胫骨端用Intrafix系统固定。11例患者均获随访,随访时间6～15个月,平均8.6个月。移植后均未出现免疫反应,移植后6个月膝关节活动良好,屈曲均超过120°,主动伸屈无障碍,Lachman试验及前抽屉试验阳性1例。移植后的Lysholm评分显著高于移植前[(92.4±4.2,43.3±2.3)分,P<0.01]。提示关节镜下同种异体腘绳肌腱移植重建前交叉韧带是治疗膝关节前交叉韧带损伤的一种较为理想的方法。

Eleven patients with anterior cruciate ligament of knee joint （ACL） injury were performed arthroscopic reconstruction of ACL by using hamstring tendon transplantation in Meihekou City Hospital from August 2006 to December 2007. The semitendinosus and gracilis tendon, which supplied by 304 Hospital of the Chinese PLA, were soak in 250 mL isotonic saline of 160 000 U cidomycin for 30 minutes, after that, measured the diameter and prepared for bone tunnel in according to tendon length. The tendon from the lateral side of femur tunnel was inserted into tibial tunnel, the femur tunnel was fixed by RIGIDfix, followed by a knee bend in full extension and flection for 20 times under 0°-120°, the Intrafix system was used to fix the tibia tunnel. All of 11 cases were followed up for an average of 8.6 months （ranged from 6 to 15 months）. There was no immunological reaction, and the movement of knee joint shows excellent with over 120° flexion angle at 6 months after operation. One case was positive to anterior drawer test and Lachman test. The Lysholm score was significantly higher than that of before operation （92.4±4.2, 43.3±2.3, P 〈 0.01）. The result demonstrates that it is an ideal means to reconstruction ACL by using hamstring tendon transplantation under arthroscope.