关节镜下保留残端股骨双隧道双束后交叉韧带重建术

Arthroscopic double-bundle reconstruction of posterior cruciate ligament with double-femur-tunnel and remnant preservation

目的评估关节镜下保留残端股骨双隧道双束后交叉韧带(PCL)重建术的临床效果。方法 2007年6月～2009年5月对19例PCL患者行保留残端股骨双隧道双束重建,股骨双隧道位于PCL原附着区,前外侧束位于10:30(左)或1:30(右),距关节软骨7mm;后内侧束位于8:30(左)或3:30(右),距关节软骨10mm。术中保留PCL残端纤维及周围滑膜组织,移植物采用自体股薄肌和半腱肌肌腱。结果全部病例随访12～20个月,平均18个月。后抽屉实验(PDT)术前(++)不稳12例,(+++)不稳7例;术后(-)16例,(+)不稳3例。仪表盘试验用于评估评估旋转稳定性,术前不稳11例,术后全部(-)。国际膝关节评分委员会(IKDC)评分术前平均(61.12±4.80)分,术后平均(92.25±4.50)分,差异有显著性(P<0.05)。其中正常15例,接近正常4例。Lysholm评分由术前(54.23±5.20)分提高到术后(90.13±6.10)分,差异有显著性(P<0.05)。结论保留残端股骨双隧道双束PCL重建术可获得良好的临床结果,符合解剖重建,能较好控制胫骨后向及旋转移位。

Objective To evaluate the clinical outcomes of arthroscopic double-bundle reconstruction of posterior cruciate ligament with double-femur-tunnel and remnant preservation.Methods From June 2007 to May 2009,19 patients were treated with double-bundle PCL reconstruction under arthroscopy with double-femur-tunnel and remnant preservation.The two femoral tunnels were placed on footprint,anterolateral bundle was centered at 7mm from the articular cartilage at 10：30 （left） or 1：30 （right） o＇clock,while posteromedial bundle was centered at 10mm from the articular cartilage at 8：30 （left） or 3：30 （right） o＇clock.Residual PCL and surrounding synovial tissue saved during operation.Hamstring tendon was used as autograft.Results Average follow-up was 18 months （12～20 months）.Twelve patients showed PDT （＋＋） instability and seven patients showed PDT （＋＋＋） instability preoperation,while sixteen cases showed negative PDT and three cases showed （＋） instability postoperation.Rotational laxity was identified by dial test results,and eleven cases showed positive dial test preoperation while all cases showed negative postoperation.IKDC score was significantly changed from （61.12±4.80） to （92.25±4.50）.In IKDC evaluation fifteen patients were graded as normal and four patients were graded as nearly normal.Lysholm score was significantly increased from （54.23±5.20） to （90.13±6.10）.Conclusions The results of this study showed that double-bundle reconstruction of posterior curciate ligament with double-femur-tunnel and remnant preservation can yield satisfied clinical outcomes.It mimics anatomic reconstruction and better stabilizes posterior and rotation tibial translation.