保留残端半腱肌和股薄肌双股双隧道解剖重建前交叉韧带的临床研究

Anatomical reconstruction of double-bundle anterior cruciate ligament with gracilis and semitendinosus tendons in arthroscopy

目的探讨关节镜下半腱肌股薄肌保留残端双股双隧道解剖重建前交叉韧带(ACL)的疗效。方法回顾自2006年1月～2008年1月,本组在关节镜下联合应用半腱肌腱和股薄肌腱双股双隧道重建ACL患者20例其中男18例,女2例,年龄17～46岁(平均31.5岁)。取腱器分别切取半腱肌、股薄肌编织成股,保留前叉韧带在股骨、胫骨的附着点残端,于ACL前内侧束和后外侧束附着部分别钻隧道,用半腱肌腱重建前内侧束,股薄肌腱重建后外侧束,以enderbutton悬吊固定股骨端,挤压螺钉固定胫骨端肌腱。所有患者术前及术后12个月行前抽屉试验、Lachman试验、Lysholm评分方法评定膝关节功能。结果术后随访14～48个月,平均31个月。术前患者前抽屉试验均为阳性,Lachman试验阳性13例,术后前抽屉试验3例屈膝60°位阳性,1例屈膝30°位阳性,其余均转阴性。5例Lachman试验仍阳性,但患者术后无膝关节不稳。2例患者术后胫骨前伤口瘢痕红肿凸起,给予切开引流后良好愈合。用Lysholm膝关节功能评分法评定术后疗效,术前评分为38～49分,平均43.5分,术后14个月为69～92分,平均80.5分,优13例,良5例,可2例,优良率为90.0%。结论应用自体肌腱双股双隧道重建ACL,术后膝关节动态稳定性好,疗效满意。

Objective To explore the effect of arthroscopic reconstruction of double-bundle anterior cruciate ligament（ACL） anatomically with gracilis and semitendinosus tendons.Methods From January of 2006 to that of 2008,20 patients who accepted arthroscopic reconstruction of double-bundle ACL anatomically with gracilis and semitendinosus tendons were followed up.There were 18 male and two female patients aging from 17 to 46 （mean 31.5） years old in this group.Anterior drawer test were positive in all the patients,Lachman test in 13 cases,Bohler sign in six cases and McMurray sign in eight cases were positive.Nine patients were accompanied were with meniscus rupture and five patients were with collateral ligament injury.Three cases were found tibia intercondyloid spine avulsion fracture in radiograph.Two bone tunnels of 4.5 mm diameter were made in the tibial and the femoral attachment site of ACL anteromedial bundle and posterolateral bundle respectively.The anteromedial bundle was reconstructed using semitendinosus tendon.The ACL stumps in femur or tibia side were reserved during construction.The femur tunnel was suspension-fixed by ender-button and the tendon in tibial tunnel was fixed by bioabsorbable compression screws.Anterior drawer test was performed at 30,60,90 degrees in flexion of the knee joint.Lachman test and Lysholm rating system were used to determine the function of the knee and the activity level of the patients.Results 20 patients were followed up （from 14 to 48 months,and the mean time was 31 months）.After operation,Anterior drawer test of three cases was positive in 60 degrees and one case in 30 degrees flexion.Other Patients turned negative.Lachman test was still positive in five cases,but the patients felt no unstableness.The average Lysholm score which was 43.5 points （range 38 to 49 points） before operation,improved to 80.5 scores （range 38 to 49 scores） 14 months after operation.The excellent and good rate was 90.0%.Conclusions The effect of combined double-bundle ACL reconstruction was satisfied.