关节镜下胫骨双隧道股骨单隧道八股同种异体肌腱重建膝前交叉韧带

Re-establishing anterior cruciate ligament of knee by using twin tunnels in tibia and single tunnel in femur with eight bundles of allogeneic tendons through arthroscope

目的介绍关节镜下胫骨双隧道股骨单隧道八股同种异体肌腱重建膝前交叉韧带(anterior cruciate ligament,ACL)的手术方法以及应用体会。方法关节镜下对67例(70个膝)膝关节ACL断裂患者应用同种异体肌腱反折编织形成八股"人"字形移植物,采用胫骨双隧道、股骨单隧道界面螺钉固定的方法重建ACL,观察近期术后疗效,以Lysholm评分、Larson评分及IKDC评分评价比较手术前后膝关节功能,以MRI及X线观察骨隧道变化情况。结果62例患者(65个膝关节)获得随访,随访时间4～20个月,平均13个月。关节活动度均正常,Lysholm评分由术前(57.4±3.3)提高到(93.8±3.4)分;Larson评分由(54.3±3.8)提高到(92.7±2.5)分,IKDC评分由(59.6±2.4)提高到(93.5±4.2)分,差异均有统计学意义;复查MRI,5例患者出现骨隧道扩大:2例股骨及胫骨前内侧隧道均扩大,3例为前内侧骨隧道。所有患者均未见关节间隙变窄,均未出现螺钉松动、移植物松动。结论应用八股同种异体肌腱胫骨双隧道、股骨单隧道界面挤压螺钉固定重建ACL手术操作简便,关节稳定性佳,最大限度恢复解剖重建,近期疗效佳,远期效果有待进一步观察。

[ Objective ] To introduce the operation method and the comprehension of re-establishing anterior cruciate ligament （ ACL）of knee through arthroscope by using eight bundles of allogeneic tendons. [Methods] In 67 cases of patients （70 knees） whose anterior eruciate ligaments were broken, allogeneie tendons were weaved in fold to make eight bundles of transplants. Anterior crueiate ligaments of knee were re-established by using twin tunnels in tibia and single tunnel in femur with screws pinning in the surfaces through arthroscope, and the security and curative effect in the near future were overviewed after the operation. The pre-operative and perioperative knee-joint functions were compared using Lysholm mark, Larson mark and IKDC mark; the bone tunnel changes were detected by MRI and X-ray. [Results] It took 4 to 20 months （13 months in average） to follow up 62 patients （ 65 knee joints）. Joint motion was normal, Lysholm mark was elevated from pre-operative （57.4：1：3.3） score to post-operative （93.8±3.4） score; Larson mark was from （54.3±3.8） score to （92.7±2.5） and IKDC mark was from （59.6±2.4） to （93.5± 4.2）, the differences had statistical significance. Rechecked by MRI, 5 eases had the expandition of bone tunnels, in while 2 cases had enlarged tunnels in both femur and anterior medial tibia and 1 in anterior medial tibia. None had joint space narrowing or instability of screw and transplants. [Conclusion] Reestablishment of ACL of knee with eight bundles of transplants weaved by homogeneous but variant tendons in fold by using twin tunnels in tibia and signal tunnel in femur and screws pinning in the surfaces under arthroscope has the merits of convenient operation, good joint stability, establishment of the normal anatomical construction to the most extent, and excellent short-term therapeutic effect. However, the long-term effect is uncertain.