关节镜下自体腘绳肌腱重建前交叉韧带单束损伤

ARTHROSCOPIC RECONSTRUCTION OF ANTERIOR CRUCIATE LIGAMENT FOR SINGLE BUNDLE RUPTURE WITH HAMSTRING AUTOGRAFT

目的探讨保留剩余纤维束应用自体腘绳肌腱重建前交叉韧带(anterior cruciate ligament,ACL)单束损伤的疗效。方法 2005年3月-2009年5月,采用保留剩余纤维束、自体腘绳肌腱重建ACL单束损伤20例。男15例,女5例;年龄16～43岁,平均25.5岁。均为运动损伤。左膝12例,右膝8例。其中前内侧束断裂11例,后外侧束断裂9例。10例前抽屉试验阳性,8例Lachman试验阳性,2例两项试验均为阳性。Lysholm评分为(67.0±6.2)分,国际膝关节评分委员会评分(IKDC)为(69.0±7.5)分。受伤至手术时间1周～12个月,平均2.8个月。结果术后切口均Ⅰ期愈合。20例均获随访,随访时间12～36个月,平均18.5个月。末次随访时,膝关节活动度均达130°。17例前抽屉试验及Lachman试验阴性;2例前抽屉试验弱阳性,Lachman试验阴性;1例Lachman试验弱阳性,前抽屉试验阴性。末次随访时,Lysholm评分为(91.0±3.7)分,IKDC评分为(92.0±4.9)分,与术前比较差异均有统计学意义(P<0.05)。结论保留剩余纤维束支自体腘绳肌腱重建ACL单束损伤,部分保留了膝关节本体感觉,有利于维持膝关节稳定性。

Objective To investigate the effectiveness of anterior cruciate ligament（ACL） reconstruction for single bundle rupture using hamstring autograft with preservation of the left bundle. Methods Between March 2005 and May 2009,20 patients with ACL single bundle rupture were treated using hamstring autograft with preservation of the left bundle.There were 15 males and 5 females with an average age of 25.5 years（range,16-43 years）.Injury was caused by sports in all the patients.The locations were the left knee in 12 cases and the right knee in 8 cases,including 11 cases of antero-medial bundle rupture and 9 cases of postero-lateral bundle rupture.Ten patients had positive results of anterior drawer test,8 patients had positive result of Lachman test,and 2 patients had positive results of both tests.The Lysholm score was 67.0 ± 6.2 and International Knee Documentation Committee（IKDC） score was 69.0 ± 7.5.The time from injury to surgery was 1 week to 12 months（mean,2.8 months）. Results All the patients had healing of incision by first intention.Twenty patients were followed up 18.5 months on average（range,12-36 months）.The range of motion of all the knees was more than 130° at last follow-up.The results of both the anterior drawer test and Lachman test were negative in 17 patients.The result of anterior drawer test was weakly positive and the result of Lachman test was negative in 2 patients.The result of Lachman test was weakly positive and the result of the anterior drawer test was negative in 1 patient.The Lysholm score and the IKDC score were 91.0 ± 3.7 and 92.0 ± 4.9 at last follow-up,showing significant differences when compared with the preoperative ones（P 0.05）. Conclusion ACL reconstruction using hamstring autograft with preservation of the left bundle has satisfactory effects and can partially preserve the proprioceptive sense of the knee,which is beneficial for improving the stability of the knee.