关节镜下四股自体腘绳肌腱重建前交叉韧带单束损伤

Single bundle reconstruction of anterior cruciate ligament by Quadrupled hamstring tendons in arthroscopy

目的:探讨关节镜下应用自体腘绳肌腱重建前交叉韧带(anterior cruciate ligament,ACL)单束损伤的方法及疗效。方法:ACL单束损伤者35例,其中,男24例,女11例,年龄18～45岁,平均24.8岁。全部患者均由膝关节镜确诊为前交叉韧带单束损伤,其中前内侧束(AMB)断裂13例,后外侧束(PLB)断裂22例。保留未断裂的剩余束支,在关节镜下分别于ACL断裂束支的止点建立胫骨和股骨隧道。股骨侧以Endo-button悬吊固定,胫骨侧以界面螺钉挤压固定。术后用下肢支具固定于伸直位。结果:术后随访13～35个月,平均23.6个月。术后膝关节功能改善,稳定性增强,术后屈膝90°时前抽屉试验阴性33例,阳性2例;Lachman试验32例,弱阳性2例,阳性1例。Lysholm评分术前(61.0±6.2)分,术后(91.0±2.8)分,平均提高30.0分,术后总体优良率达95.7%。结论:保留剩余束支重建前交叉韧带单束损伤可以部分保留膝关节的本体感觉,有利于维持膝关节的稳定性,并且有利于移植肌腱的再血管化。

Objective：To investigate the method and the effect of anterior cruciate ligament（ACL） reconstruction for single bundle with arthroscopy using quadrupled hamstring autograft.Methods：Thirty-five patients（24 males and 11 females） of ACL single bundle rupture were included in this research,with an average age of 24.8（18-45） years.All the patients were finally diagnosed with arthroscopy.There were nine patients of antero-medial bundle rupture and fourteen patients of pos tero-lateral bundle rupture.The femoral and tibial tunnels were drilled at the foorprint of the ruptured bundle respectively and the disruptured bundle was preserved.The ruptured bundle was reconstructed with quadrupled hamstring autograft.The tendons were fixed with endo-button at the femoral side and with intra-fix bioscrew at the tibial side.Radiofrequency shrinkage of the disruptured bundle was made to enhance its tension.Results：All the patients had improvement of knee function during the follow-up periond of 23.6（13-35） months.Weak positve in two patients was with the knee in 90 °degrees flextion.Positive was only one patient.The Lysholm score improved from（61.0±6.2） scores preoperatively to（91.0± 2.8） scores postoperatively.95.7 percent of patients had good or fine results.Conclusions：ACL reconstruction with preserving the disruptured bundle can partially preserve the proprioceptive sense of the knee.It is beneficial for improving the stability of the knee and profitable for the revascularization of the tendon graft.