关节镜下八股腘绳肌腱双束重建前交叉韧带的临床疗效

Clinical effect of double bundle anterior cruciate ligament reconstruction under arthroscope using eight strands of hamstring tendon

目的探讨关节镜下八股胭绳肌腱双束重建前交叉韧带（ACL）的方法和手术效果。方法2005年10月至2009年10月对49例ACL损伤患者在关节镜下行8股胭绳肌腱双束双隧道重建ACL。取半腱肌腱折叠为4股重建前内侧束，取股薄肌腱折叠为4股重建后外侧柬，做胫骨、股骨双隧道，股骨端采用缝合钢板悬吊固定，胫骨端采用缝合纽扣固定肌腱；或者取一侧的半腱肌和股薄肌肌腱折叠为4股重建前内侧束，另一侧的半腱肌和股薄肌肌腱折叠为4股重建后外侧束，股骨端用微创钢板（Endbutton）固定，胫骨端用界面螺钉固定。采用Lysholm膝关节评分标准评价疗效。结果所有患者接受12～24个月（平均18个月）随访，除1例取腱处感染外，其余48例功能康复满意。49例患者中轴移试验I度阳性3例，Lachman试验I度阳性3例，屈膝90。前抽屉试验I度阳性2例，证实膝关节稳定性良好；Lysholm评分从术前平均（50±7）分提高到术后（93±7）分，差异有统计学意义（P〈0．01）。结论八股胭绳肌腱双束重建ACL术后膝关节可获得良好的稳定性。

Objective To describe the techniques and the results of double bundle anterior cruciate ligament（ACL） reconstruction under arthroscope using eight strands of hamstring tendon. Methods Forty - nine cases of ACL ruptures were taken reconstruction with eight - stranded hamstring tendon in a two - bundle and four - tunnel way under arthroscopy from October 2005 to October 2010. Taking four strands of semitendinous tendon to replace anterior medial bundle, four strands of gracilis tendon to build posterior lateral bundle, through double bone tunnels of tibia and femur, the ligaments were fixed using aesculap implant of braun company. Or taking four - strand of gracilis and semitendinous tendon from one side to reconstruct AM bundle, four - strand of gracilis and semitendinous tendon from the other side to reconstruct PL bundle, the grafts were fixed using Endobutton on femur side and bioscrew on tibial side. The clinical results were evaluated according to Lysholm rating scales. Results All the patients were followed up for 12 to 24 months（mean, 18 months）. Except one case was infected, the other 48 cases were satified with function rehabilitation. Pivot shift test was one degree positive in 3 cases, Lachman test was one degree positive in 3 cases, and anterior drawer test was one degree positive in 2 cases, proving good results of stability of the knee. The Lysholm score increased from （50± 7 ） before operation to （93 ± 7 ） after operation, there was significant difference （ P 〈 0. 01 ）. Conclusions Reliable stability can be obtained after anterior cruciate ligament reconstruction using eight strands of hamstring tendon.