关节镜下RetroButton-同种异体肌腱-界面螺钉重建前交叉韧带的近期疗效

SHORT-TERM EFFECTIVENESS OF ARTHROSCOPIC ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH RetroButton-ALLOGENEIC TENDON-INTERFERENCE SCREW

目的探讨关节镜下应用RetroButton-同种异体肌腱-界面螺钉重建前交叉韧带的手术方法与近期疗效。方法 2009年6月-10月,于关节镜下采用RetroButton-同种异体肌腱-界面螺钉重建23例前交叉韧带损伤。男15例,女8例;年龄19～46岁,平均32.5岁。左膝17例,右膝6例。致伤原因:运动伤13例,交通事故伤8例,坠落伤2例。急性损伤(<6周)7例,慢性损伤(>6周)16例。合并单纯内侧半月板损伤11例,单纯外侧半月板损伤6例,内、外侧半月板同时损伤3例,关节软骨损伤5例。患者均无后交叉韧带、内外侧副韧带或后外侧结构损伤。受伤至手术时间3周～32个月。按照Lysholm评分和国际膝关节评分委员会(IKDC)膝关节评分标准进行主观评估;采用Lachman试验和KT-1000关节测量仪检查进行客观评估。结果术后患者切口均Ⅰ期愈合,患膝关节失稳症状明显改善。无高热、感染或明显排斥反应。1例患者术后发生顽固性滑膜炎,关节内反复积液,3周内经关节腔灌洗7次后稳定。患者均获随访,随访时间10～17个月,平均14.7个月。末次随访时IKDC评分、Lysholm评分、Lachman试验及KT-1000检测与术前比较,差异均有统计学意义(P<0.05)。结论关节镜下应用RetroButton-同种异体肌腱-界面螺钉重建前交叉韧带手术操作安全、简便,近期疗效满意。

Objective To investigate the method and short-term effectiveness of arthroscopic reconstruction of anterior cruciate l igament （ACL） using RetroButton-allogeneic tendon-interference screw. Methods Between June 2009 and October 2009, 23 patients with ACL rupture were treated by arthroscopic reconstruction with RetroButton-allogeneic tendon-interference screw. There were 15 males and 8 females with an average age of 32.5 years （range, 19-46 years）, including 17 left knees and 6 right knees. The injury causes were sport trauma （13 cases）, traffic accident （8 cases）, and fall ing injury （2 cases）. There were 7 acute cases （〈 6 weeks） and 16 chronic cases （〉 6 weeks）. Among the cases, 11 cases compl icated by medial meniscus injury, 6 by lateral meniscus injury, 3 by the both injuries, and 5 by articular cartilage injury. All cases had no injuries of posterior cruciate l igament, medial or lateral collateral l igament, or posterolateral structure. The time from injury to operation ranged from 3 weeks to 32 months. Lysholm and International Knee Documentation Committee （IKDC） scores were used for subjective evaluation, while Lachman test and KT-1000 measurement for objective evaluation. Results All wounds healed by first intention. The symptoms of unstable knee were improved obviously. No high fever, infection, or immunologic rejection were observed. Refractoriness synovitis and joint effusion occurred in 1 case after operation, and was improved after articular cavity flushing for 7 times within 3 weeks. All cases were followed up 10-17 months （mean, 14.7 months）. There were significant differences in Lysholm score, IKDC score, Lachman test, and KT-1000 measurement between pre-operation and last follow-up （P 〈 0.05）. Conclusion Arthroscopic reconstruction of ACL with RetroButton-allogeneic tendon-interferencescrew is simple and safe, and its short-term effectiveness is satisfactory.