陈旧性前交叉韧带损伤四股腘绳肌腱重建中髁间窝成形术的应用价值

Application value of femoral intercondylar notch plasty in quadruple hamstring tendon reconstructing for old anterior cruciate ligament injury

目的探讨陈旧性前交叉韧带（ACL）损伤采用四股胭绳肌腱重建的临床疗效及髁间窝成形术的应用价值。方法关节镜下采用四股半腱肌腱及股薄肌腱重建治疗56例陈旧性ACL损伤患者，其中45例应用髁间窝成形术。56例患者术前Lachman试验（＋），MRI证实ACL损伤，按照Lysholm膝关节评分及KT-1000关节测量仪测定结果评价疗效。结果56例患者均获得随访，随访时间6-24（13．0±4．2）个月，术后Lachman试验（-）53例，（±）3例。Lysholm膝关节评分由术前的（56．0±7．3）分增加至术后随访时的（93．0±3．5）分，差异有统计学意义（t=34．20，P＜0．01）。术后KT-1000关节测量仪测定患者双侧膝关节前向松弛度差值＜3．0mm、平均移动度（2．0±0．6）mm，与术前双侧膝关节前向松弛度差值≥3．0mm、平均移动度（3．0±1．2）mm比较差异有统计学意义（t=5．58，P＜0．05）。结论关节镜下四股胭绳肌腱重建ACL，疗效确切，术后患者可早期康复锻炼。术中应用髁间窝成形术，可减少术后撞击综合征，且骨隧道定位准确，提高了手术疗效。

Objective To investigate clinical efficacy of reconstructing for old anterior cruciate ligament（ACid） injury with quadruple hamstring tendon, and application value of femoral intercondylar notch plasty. Methods Fifty-six cases of old ACL injury were reconstructed arthroscopically with quadruple hamstring tendon. Forty-five eases were used femoral intercondylar notch plasty. Preoperative Lachman test were positive,and ACL injury were confirmed by MRI. The curative effect was evaluated according to Lysholm knee score and KT-1000 measurement results. Results All of the 56 patients were followed up for 6-24 （13.0 ± 4.2） months. Postoperative Lachman test of 53 cases were negative,and 3 eases were weak positive. The Lysholm knee score increased from preoperative （56.0 ± 7.3 ） scores to postoperative （93.0 ± 3.5） scores, comparison of preoperative had significant difference （t = 34.20,P 〈 0.01 ）. The postoperative KT-1000 measurement showed 〈 3.0 mm side difference of anterior laxity,moving average of （2.0 ± 0.6） ram, comparison of preoperative ≥ 3.0 ram, moving average of （3.0 ± 1.2 ）mm had significant difference（t = 5.58, P 〈 0.01 ）. Conclusions Arthroscopie reconstruction of ACL with quadruple hamstring tendon have a good effect. The postoperative rehabilitation exercise can practise early. The femoral intercondylar notch plasty which used during operation is benefit of decreasing femoral intereondylar notch impingement syndrome, accurate positioning femur tunnel, and increasing curative effect.