关节镜下膝关节前交叉韧带分束重建的临床研究

The chinical study of different bundle reconstruction of anterior cruciate ligament under arthroscopy

目的探讨关节镜下前交叉韧带(ACL)部分断裂的分束重建手术方法及近期疗效。方法在关节镜下对26例膝关节ACL部分断裂患者采用自体腘绳肌腱或同种异体肌腱进行分束重建术,观察其术后近期疗效,以Lysholm评分、Larson评分、IKDC评分评价膝关节功能。结果24例患者获随访,随访时间12～36个月,平均23个月,所有患膝关节活动度正常,平均Lysholm评分由术前(69±6.3)分提高到(92.4±2.6)分(t=17.5,P<0.01),Larson评分由术前(70±4.5)分提高到(93.2±2.5)分(t=23.0,P<0.01),IKDC评分由术前(67.3±6.4)分提高到(92.5±3.1)分(t=18.1,P<0.01),差异均有统计学意义;复查X线照片及MRI均未发现骨隧道扩大现象,未见关节间隙变窄及挤压螺钉松脱。结论根据ACL损伤的不同程度,进行关节镜下ACL分束重建手术操作简便,最大限度恢复解剖重建,功能恢复快,近期疗效佳。

Objective To discuss the surgical technigue and the recent clinical effect of different bundle reconstruction on partial anterior cruciate ligament（ACL） tear under arthroscopy. Methods In 26 patients whose ACL had partial bundle broken, the different bundle reconstruction of ACL were performed with autoallergic （ 8 cases ） or alloallergid tendon （ 18 cases ）. Functional rehabilitation training was performed after the reconstruction, Lysholm ,Larson and IKDC were used to evaluate the knee function pre and post operation. Results 24 cases were followed up for 12 to 36 months, 23 months in average. The range of knee motion was normal, the Lysholm score increased from （ 69 ±6. 3 ） to （ 92. 4 ± 2. 6 ） after operation, Larson score increased from （70 ±4. 5 ） to （93.2 ±2. 5） and the IKDC score increased from （67.3 ±6.4） to （92. 5 ±3. 1）, difference was found to be significant. According X - ray and MRI, there were no expanding of the tunnel, no narrowness in joint space and no screw loosening. Conclusions According to the degree of ACL injuries, different bundle construction can reconstuct the normal anatomy and fast recover the knee. The short-term clinical effect is excellent.