腘绳肌腱移植皮质骨挤压钉固定重建前交叉韧带

Tendon graft fixation in anterior cruciate ligament reconstruction with cortical press-fit bolt

目的探讨腘绳肌腱移植同种异体皮质骨挤压钉固定腘绳肌腱重建前交叉韧带的临床效果。方法 2010年1-12月采用Endobutton+骨挤压钉固定股骨端,门形钉或Rigidfix固定胫骨端重建前交叉韧带(ACL)17例,男14例,女3例,平均年龄28.6(15-49)岁,术前、术后使用Rolimeter测量胫骨前移度并采用Lysholm评分系统评定膝关节功能,术后X-Ray及MRI检查。结果术后随访6.9(3-13)个月。所有患者均无感染、神经血管损伤等并发症发生,X-Ray显示骨挤压钉术后3月后逐渐爬行替代。患者术前双侧膝关节、患侧膝关节术前与术后比较胫骨前移度差异有统计学意义(P<0.01);而患侧膝关节术后与健侧膝关节比较胫骨前移度差异无统计学意义(P>0.05);患侧膝关节术后1个月、3个月比较,胫骨前移度差异无统计学意义(P>0.05)。Lysholm评分:术前(31.1±6.3)分,术后(85.2±6.9)分(P<0.001),优良率88.2%。结论同种异体皮质骨挤压钉可满足ACL重建初始固定要求,组织相容性好。

Objective To study the clinical outcome of tendon graft fixation in anterior cruciate ligament（ACL） reconstruction with cortical press-fit bolt（CPB）.Methods The femoral end was fixed with Endobutton＋CPB,ACL was reconstructed by fixing tibia with Rigidfix from January 2010 and December 2010 in 17 patients（14 males and 3 females） at the age of 28.6 years（range 15-49 years）.The forward shift of tibia was measured with Rolimeter and the knee function was assessed using the Lysholm scoring system before and after operation.The patients received X-ray and MRI examination after operation.Results The patients were followed up for 6.9 months（range 3-13 months） during which no infection and complications of nerve and blood vessels occurred.X-ray showed that CPB was replaced by creeping fibers 3 months after operation.Significant differences were found in forward shift of tibia before and after operation（P0.01）.However,no significant difference was observed in forward shift of tibia between the affected and healthy knees.The preoperative Lysholm score was 31.1±6.3 before operation and 85.2±6.9 after operation（P0.001）.The total excellent and good rate was 88.2%.Conclusion CPB fixation can meet the physiological demand of ACL reconstruction with a good histocompatibility.