关节镜下自体髌腱中1/3重建前交叉韧带

Reconstruction of Anterior Cruciate Ligament by Bone Patellar Tendon Bone under Arthroscopy

关节镜下采用自体骨—髌韧带一骨（Ｂ—ＰＴ—Ｂ），挤压螺丝钉固定，等长重建膝关节前交叉韧带（ＡＣＬ），具有创伤小、关节内环境影响小，而且可同时进行关节内其它手术，术后病人恢复快的特点。手术的关键是获取标准的髌腱两端骨块和股骨、胫骨隧道以及选择等长点，并稳固地将２骨块挤压固定于骨隧道中。作者手术１２例、平均随访９个月，术前抽屉试验１２例阳性，术后２例阳性；轴移试验３例阳性，术后均消失；Ｌａｃｈｍａｎ试验术前１２例阳性，术后１例弱阳性，膝前痛２例。全部病人术后膝关节功能均有明显改善，无髌骨骨折及挤压螺丝钉松动。按照日本骨科学会制定的膝关节疗效评定标准，优５例、良５例、中２例，优良率达８３．３％。

A technique under arthroscopy for anterior cruciate ligament (ACL)reconstruction using the mid one third of autologous Bone Patellar Tendon Bone(B PT B)graft is described.The procedure not only have the advantage of minimal injury,rapid rehabilitation but also can deal with the other pathological conditions within knee joint at one sitting.A special technique using an oscillation hollow saw allows for the rapid and standardized harvest of cylindrical bone plugs,ensuring saft and adequate femoral press fit fixation.12 patients were operated.Mean follow up period were 9 months.The anterior Drawer Test (ADT)was positive in 12 preoperatively and 2 postoperatively,The pivot shift test was positive in 3 cases preoperatively and 0 postoporatively.The Lachmans test 12 cases positive preoperatively and only one weak positive postoperatively.Two cases still had anterior patellar pain.All the pationts had apparent improvements in function walking and in daily life postoperatively without complicalions of patellar fracture and loosening of the interference screws According to the criteria of Japanese Association of Orthopaedics responding to the function of the knee joint,excellent results were seen in 5 patients,good in 5 and fair in 2. The excellent and good rate was 83 3%.So reconstruction of ACL under arthroscopy is worthy to be applied widely.