关节镜下胫骨Inlay技术重建后十字韧带的近期疗效

Full arthroscopic dual-beam reconstruction of the posterior cruciate ligament using tibial Inlay technique

目的 探讨关节镜下胫骨Inlay技术双束重建后十字韧带（posterior cruciate ligament,PCL）的近期疗效.方法 2007年3月至2009年9月,采用关节镜下胫骨Inlay技术行双束PCL重建且随访超过1年的PCL损伤患者17例,男16例,女1例；年龄19～54岁,平均25岁.术前Lysholm膝关节评分（53.4±2.1）分；国际膝关节评分委员会（International Knee Documentation Committee,IKDC）分级C级7例,D级10例；后抽屉试验阳性17例.术中采用自行设计的胫骨后方倒打隧道钻具系统制作限深骨隧道.随访时行膝关节X线摄片和螺旋CT检查,观察嵌入骨栓的位置和愈合情况.末次随访时评估Lysholm膝关节评分、IKDC分级及后抽屉试验,比较与术前的稳定性差异.结果 17例患者均获得随访,随访时间12～28个月,平均17.8个月.末次随访时Lysholm膝关节评分（93.5±1.7）分,与术前比较差异有统计学意义（P=0.016）；IKDC分级A级15例、B级2例,与术前比较差异有统计学意义（P=0.021）；后抽屉试验阴性15例,弱阳性2例.术后12周X线片和螺旋CT示嵌入骨栓的位置满意,愈合良好.结论 胫骨后方倒打隧道钻具系统可以准确制作限深骨隧道,创伤小,使用这种钻具系统的PCL重建术近期疗效好.

Objective To investigate the recent effect of full arthroscopic dual-beam reconstruction of the posterior cruciate ligament（PCL）using tibial Inlay technique.Methods From March 2007 to September 2009,17 PCL injured patients underwent full arthroscopic dual-beam PCL reconstruction using Inlay technique,including 16 males and 1 female,with an average age of 25 years（range,19-54）.Of all cases,Lysholm score was（53.4±2.1）points,International Knee Documentation Committee（IKDC）rated C in 7,D in 10,and posterior drawer test（＋）in 17.We used self-designed tibia tunnel drill system to produce the deep-limited bone tunnel.Follow-up began at 12 months after operation.Evaluate Lysholm knee score,IKDC rating,and posterior drawer test to compare the knee stability with that of preoperative.Observe the location of the bone block and healing by checking knee X-ray and spiral CT scan.Results Seventeen patients were followed up between 12 to 28 months,with an average of 17.8 months.In the last follow-up study,Lysholm score（93.5±1.7）points compared with that of preoperative was statistically significant different（P=0.016）.IKDC rating of A grade in 15 cases,B in 2,compared with that of preoperative was statistically significant different（P=0.021）.Posterior drawer test were negative in 15 cases,slight positive in 2.The X-ray and spiral CT scan showed the location of the bone block were perfect and healed well.Conclusion We can accurately produce the deep-limited bone tunnel by the tibia tunnel drill system with minor trauma,and the recent clinical effects of PCL reconstruction were pretty good.