同种异体肌腱材料重建膝关节后交叉韧带合并后外侧复合体损伤

Tendon allograft materials for repair of posterior cruciate ligament injury combined with posterolateral complex injury

背景:膝关节后交叉韧带合并后外侧复合体损伤重建中移植物的选择迄今仍存在争议。目的:观察异体肌腱材料应用于重建膝关节后交叉韧带并后外侧复合体损伤的效果。方法:经关节镜证实为膝关节后交叉韧带并后外侧复合体损伤患者15例,均使用山西省医用组织库提供同种异体肌腱,重建后交叉韧带并后外侧复合体,重建中尽量保留原后交叉韧带残迹,制备后交叉韧带胫骨及股骨隧道,引入修整后同种异体肌腱并挤压螺钉固定。结果与结论:重建后膝关节屈伸度较重建前明显改进(P<0.01),重建前后抽屉试验2+程度4例,4+程度11例,重建后后抽屉试验阴性8膝,后抽屉试验1+有6例,2+有1例,膝关节伸直位、屈曲30°位内翻试验均为阴性,显示关节的后移程度及稳定性较重建前有明显改善。重建后膝关节Lysholm功能评分重建前明显提高(P<0.01),随访期间未见膝关节排斥、感染等并发症。结果证实,同种异体肌腱重建膝关节后交叉韧带并后外侧复合体损伤不损伤正常的自身结构,修复效果满意。

BACKGROUND：Selection of tendon allograft materials for posterior cruciate ligament（PCL）injury combined with posterolateral complex（PLC）injury is controversial.OBJECTIVE：To observe the effect of tendon allograft materials on PCL plus PLC injuries during reconstruction.METHODS：Fifteen patients with arthroscopic PCL plus PLC injuries of the knee joint received knee joint construction with tendon allograft supported by Shanxi Provincial Medical Tissue Bank.Original remnants of the PCL were retained as much as possible.PCL tibial and femoral tunnel were prepared,and extrusion screws were introduced during allogeneic tendon repair.RESULTS AND CONCLUSION：Degree of knee joint flexion and extension was improved greatly after reconstruction（P0.01）.The drawer test results showed that there were 4 cases of 2＋and 11 of 4＋before reconstruction as well as 8 negative cases,6 of 1＋ and 1 of 2＋after reconstruction.After reconstruction,the varus stress test was negative at 30° of flexion and full extension,indicating that the retrusion degree and stability of the joint was significantly improved.Lysholm scores had a great increased as compared with before reconstruction（P 0.01）.No knee joint rejection,infection and other complications were found during the follow-up period.The results confirmed that the tendon allograft reconstruction of PCL plus PLC injuries cannot damage the normal structure with satisfactory effects.