关节镜下同种异体胫前肌肌腱重建膝关节前后交叉韧带损伤的疗效观察

INITIAL THERAPEUTIC EVALUATION OF ARTHROSCOPIC RECONSTRUCTION OF ANTERIOR AND POSTERIOR CRUCIATE LIGAMENT INJURY WITH ANTERIOR TIBIALIS TENDON ALLOGRAFT

目的探讨关节镜下同种异体胫前肌肌腱移植重建前交叉韧带(anterio rcruciate ligament,ACL)和后交叉韧带(posterior cruciate ligament,PCL)的手术方法及疗效。方法2005年2月-2006年7月,收治10例ACL及PCL同时断裂患者。男7例,女3例;年龄18～45岁,平均30.2岁。左膝6例,右膝4例。均有明确外伤史。病程1～3周,平均1.8周。关节镜下取26～28cm同种异体胫前肌肌腱重建ACL及PCL。术后伸膝位支具制动4周,4周后开始0～90°主动屈膝功能锻炼,6周后主动屈膝>90°。结果手术均顺利完成,术中未发生血管、神经损伤。手术时间90～110min,平均100min。切口均Ⅰ期愈合,无早期并发症发生。10例均获随访,随访时间12～15个月,平均13.5个月。行走步态正常,关节活动度为0～135°。10例膝关节前抽屉试验及内外侧应力试验均为阴性;后抽屉试验8例阴性,2例分级Ⅰ度。2例术后4d出现膝关节积液,经抽液和注射透明质酸钠后消失。Lysholm膝关节功能评分由术前(24.89±5.39)分升至术后12个月的(96.00±4.59)分,差异有统计学意义(P<0.05)。结论关节镜下同种异体胫前肌肌腱重建ACL及PCL,手术时间短、并发症少、临床效果好。

Objective To study the operative procedure and e ect of arthroscopic reconstruction of both anterior cruciate ligament（ACL） and posterior cruciate ligament（PCL） with anterior tibialis tendon allograft.Methods From February 2005 to July 2006, 10 cases of both ACL and PCL rupture were reconstructed with anterior tibialis tendon allograft, including 7 men and 3 women, aging 18-45 years with an average of 30.2 years.The locations were left knee in 6 cases and right knee in 4 cases.All of them had identi ed trauma history.The disease course was about 1-3 weeks（mean 1.8 weeks）.Both ACL and PCL were reconstructed under arthroscope with allograft anterior tibialis tendon of 26-28 cm in length and immobilization with extention position brace was given for 4 weeks after operation.The active ex knee exercise was done from 0-90° at 4 weeks and more than 90° at 6 weeks.Results All operations were nished successfully, there were no blood vessel and nerve injury.The operative time was 90-110 minutes（mean 100 minutes）.The wound healed by rst intention and no early complication occurred.Ten cases were followed up for 12 months to 15 months with an average of 13.5 months.Thier gait was normal, knee activity degree was 0-135°.The anterior drawing tests and media and lateral stress tests were negative after operation in 10 cases;and the posterior drawing tests were negative in 8 cases and 2 cases was at grade I.Hydra arthrosis of knee occurred in 2 cases and was cured after remove of uid and injection of sodium hyaluronate.The Lysholm knee function score was increases from 24.89 ± 5.39 before operation to 96.00 ± 4.59 at 12 months after operation, showing signi cant di erence（P 〈 0.05）.Conclusion Arthroscopic reconstruction of both ACL and PCL with anterior tibialis tendon allograft has the advantages of short operation time, less complications and good clinical e ects.