关节镜辅助下应用自体半腱肌腱微创重建膝交叉韧带和加强重建后外侧角韧带

Reconstructing the Anterior Cruciate Ligament and Strengthening the Posterolateral Corner Ligament with Semitendinosus Tendon Autograft

目的探讨膝交叉韧带和后外侧韧带结构损伤的治疗方法 ,评估临床治疗效果。方法 2004年5月～2009年2月,对32例膝交叉韧带合并后外侧韧带结构损伤的患者,在关节镜辅助下应用自体半腱肌腱一期重建交叉韧带和加强重建后外侧角韧带。结果 32例随访1～4年,平均2.3年。所有患者在站立、行走和下楼梯时没有与膝关节后外侧不稳相关的过伸位膝关节不稳感;未发现行走时膝关节内甩者。关节活动度,屈曲110°～130°,平均118°;伸0°～5°。按照IKDC膝关节评分标准,主观评价:正常10例(31%),近似正常16例(50%),不正常6例(19%),无严重异常;客观评价48～95分,平均83分。结论对膝交叉韧带合并后外侧韧带结构损伤,通过应用自体半腱肌腱微创手术重建能够满意恢复膝关节后外侧的稳定性和关节功能。

Objective To investigate the therapeutic methods for the injuries to the anterior cruciate ligament （ACL） and posterior lateral corner （PLC）,and estimate the clinical outcomes. Methods Between May 2004 and February 2009,32 patients with injured ACL and PLC received ACL reconstruction and PLC strengthening surgery by using semitendinosus tendon autograft under the assistance of arthroscopy. Results The 32 patients were followed up for 1 to 4 years with a mean of 2.3 years after the operation. During the period,all the patients showed no signs of PLC＇s unstability-related unstable joint at hyperextension,when standing,walking or going down stairs; no patient had leg adduction when walking. The range of knee motion were 110°-130° at flexion （mean,118°）,and 0°-5° at extention. According to the norm of IKDC on patient had knee,10 patients were normal （31%）,16 patients were approximately normal （50%）,6 patients were abnormal （19%）,and no serious abnormality; the objective evaluation showed 48-95 scores with a mean of 83. Conclusions Semitendinosus tendon auto-grafting is a satisfying minimally invasive method for reconstruction of ACL,and strengthening of the PLC.