保留韧带残端的自制台阶样联合钻手术系统在腘绳肌腱结嵌入固定法重建前交叉韧带中的应用

Reconstruction of anterior cruciate ligament with quadruple hamstring tendons knot implant fixation and preservation of the remnants using special stair-like drill system

目的探讨保留韧带残端的自制台阶样联合钻手术系统在腘绳肌腱结嵌入固定法重建前交叉韧带(ACL)中应用的可行性。方法对16例ACL损伤患者采用自体半腱肌、股薄肌腱中间打结、股骨端嵌入挤压固定法镜下重建ACL。股骨隧道采用保留韧带残端的自制台阶样联合钻手术系统建立。保留原有的ACL残端。将肌腱从股骨隧道的近端经关节腔牵入胫骨隧道,将肌腱拉紧、膝关节屈伸活动20次,使肌腱结完全嵌入瓶颈状股骨隧道内。将4股肌腱从胫骨隧道和其下方10 mm处分别穿出,交叉打结并缝合固定在骨桥上。结果16例均获随访,时间6～18(10±3.85)个月。根据Lysholm膝关节功能评分:术前20～55(34.36±11.16)分;术后6个月81～97(89.44±4.62)分,术前术后比较差异有显著性(t=26.07,P<0.01)。未见滑膜炎、韧带断裂、活动明显受限等并发症。结论保留韧带残端的自制台阶样联合钻手术系统具有台阶样股骨隧道建立准确、手术操作简单、使用方便等优点,值得临床推广应用。

Objective To study the feasibility and short-term effects of reconstruction of anterior cruciate ligament （ACL） with quadruple hamstring tendons knot implant fixation and preservation of the remnants using special stairlike drill system. Methods Arthroseopic ACL reconstruction was carried out in 16 patients with ACL injuries by using the quadruple hamstring tendons knot implant fixation and two-stakeout anatomy isometric technique and preservation of the remnants using special stair-like drill system. A knot was tied in the medial part of the tendons and according to two-stakeout anatomy isometric technique group to prepare the bone tunnels of the femur and the tibia. The diameter of the tunnel 30 mm inferior to the femur was 6 - 8 mm and that superior to the spine 11 - 12 ram. The tendon from the lateral side of femur tunnel was inserted into tibia tunnel followed by knee joint motion in full extension and flexion for 20 times so that the tendon knots were absolutely inserted into the bottleneck-like femur tunnel. A hole was drilled 10 mm distal to tibia tunnel exit and 4 tendons were crossly knotted and fixed onto a bone bridge using curved clamps. Results A follow-up was made in the 16 patients for 6 - 18 months（ mean, 12 months）. The Lysholm scores were improved from a preoperative score of 20 - 55 （ 34. 36 ± 11.16） to 81 - 97 （ 89.44 ± 4. 62） at follow-up. There were significant difference between preoperative and postoperative group （ t = 26.07 ,P 〈 0.01 ）. No postoperative complications such as synovitis, ligament rupture and movement restriction occurred. Conclusions ACL reconstruction with quadruple hamstring tendons knot implant fixation and preservation of the remnants using special stairlike drill system have advantage in simple operation, anatomy isometric reconstruction, preservation of the remnants, firm fixation, less expense and easy healing.