关节镜下自体肌腱同时联合重建膝前、后交叉韧带的临床研究

Combined reconstruction of anterior cruciate ligament and posterior cruate ligament with autogenous tendons under arthroscopy

目的探讨用髌腱复合体和腘绳肌腱联合重建膝关节膝前、后交叉韧带复合损伤手术方法和手术疗效。方法确诊为前、后交叉韧带同时损伤的患者16例,其中合并内侧副韧带损伤6例,后外侧复合体损伤4例,半月板损伤6例,于伤后2～6周在关节镜下行自体移植物单束ACL和PCL联合重建术,用髌腱复合体中1/3重建ACL,腘绳肌腱重建PCL,同期用股二头肌腱的1/3重建PLC,界面可吸收挤压螺钉和横穿钉固定。结果术后随访13～28个月,平均23个月,术前Lysholm膝关节评分为0～22分,平均(8.7±3.1)分,术后升至78～91分(平均86.1±4.8分)。术前16例采用国际膝关节文件编制委员会(IKDC)综合评定为异常(C级),术后改进为随访时正常(A级)14例,接近正常(B级)2例,14例恢复伤前运动水平。术后6～8个月基本恢复正常工作和生活,12个月可以剧烈运动。结论关节镜下自体肌腱同时联合重建膝前、后交叉韧带能较好地恢复膝关节的稳定性和功能。

Objective To explore the technique and outcome of procedure of B-PT-B,semitendinosus/gracili tendons for combined reconstruction of anterior cruciate ligament（ACL） and posterior cruate ligament（PCL）.Method Sixteen diagnosed patients of ACL and PCL were enrolled,including 6 MCL patients,4 PLC patients,and 10 meniscus patients.Patients were reconstructed of combined ACL and PCL under arthroscopy 2-6 weeks after injury.1/3 of Autogenous B-PT-B was performed only for ACL,hamstring combined autogenous semitendinosus/gracili tendons only for PCL.The interface was fixed with absorbable crushing screw and crossing nail.Results All patients were followed up for a mean of 13-28 months（averaging 23 months）.According to the Lysholm rating systems,the scores were 0-27（average 8.9） preoperatively,and improved to 78-91（average 86.1） postoperatively.Based on the International Knee Documentation Committee（IKDC） evaluation,16 patients were classified as abnormal（grade C） before operation,while after operation,14 patients were classified as normal（grade A）,2 as close to normal（grade B）.Conclusion Combined reconstruction of ACL and PCL with autogenous tendons under arthroscopy can recover stabilization and function of knee.