关节镜下保留前交叉韧带残端的前交叉韧带重建

Anterior cruciate ligament reconstruction with stump retention under arthroscopy

目的探讨关节镜下前交叉韧带(ACL)损伤后,保留ACL残端,重建ACL的手术意义。方法对37例ACL损伤者应用自体半腱肌肌腱和股薄肌肌腱重建ACL。ACL股骨髁部应用Rigifix方法固定,胫骨侧应用Transfix方法固定。ACL在胫骨侧的断裂残端全部保留;股骨髁处残端前部保留,后部切除。结果37例均获随访,时间12～28(15.7±3.7)个月。膝关节纵向稳定;Lysholm评分:术前47～64(53.2±6.0)分,末次随访90～98(94.7±3.4)分,提高(41.5±2.6)分。术前术后比较差异有统计学意义(P<0.01)。术前Lachman试验(+)37例,术后Lachman试验(-)33例,弱(+)4例。术前前抽屉试验(+)23例,术后前抽屉试验(-)34例,弱(+)3例;术前轴移试验(+)25例,术后轴移试验(-)37例;IKDC评定:术前C 19例,D 18例。术后A30例,B 7例。结论保留ACL残端重建ACL,有利于移植肌腱的定位;ACL固定于ACL残端后方,避免重建的ACL被股骨髁间窝挤夹;ACL残端纤维缠绕重建的ACL,可以封闭隧道内口,避免关节液对隧道与移植肌腱潜在腔隙的冲刷。

Objective To investigate the effect of arthroscopic anterior cruciate ligament（ACL） reconstruction with stump retention.Methods 37 cases of ACL injuries were teated with autologous semitendinosus tendon and gracilis tendon reconstruction under arthroscopy.The femoral side was fixed using Rigifix and the tibial side was fixed Transfix.ACL tibial stumps were all the reserved,and femoral stumps were reserved anteriorly and excised posteriorly.Results 37 cases were followed up for 12~28（15.7±3.7） months.The vertical stability of the knee was restored;Lysholm score： Preoperative 47~64（53.2±6.0） points,the end of second follow-up of 90~98（94.7±3.4）points,raising 41.5±2.6 points（P0.01）.Preoperative Lachman test was（＋） 37 cases,while postoperative Lachman was（-） 33 cases,weak（＋） in 4 cases.Preoperative anterior drawer test was（＋） in 23 cases,postoperative anterior drawer test was（-） in 34 cases,weak（＋） in 3 cases;surgery front axle shift test was（＋） in 25 cases,postoperative pivot shift test（-） 37 cases;IKDC assessment： preoperative was C in 19 cases,D in 18 cases,which was restored to A in 30 cases,B in 7 cases.Conclusions Retaining of ACL stump is benificial to the positioning of tendon graft;ACL fixed on the rear to avoid ACL inpingment with femoral intercondylar fossa;ACL stump can close the tunnel to avoid the synovial fluid of the tunnel and the tendon graft erosion potential lacuna.