便携式下肢手术支架辅助关节镜下腓骨长肌腱重建前交叉韧带

APPLICATION OF PORTABLE BRACKET OF LOWER LIMB IN RECONSTRUCTION OF ANTERIOR CRUCIATE LIGAMENT BY LONG FIBULAR MUSCLE TENDON UNDER ARTHROSCOPY

目的探讨采用便携式下肢手术支架辅助关节镜下腓骨长肌腱重建前交叉韧带的疗效。方法 2008年3月-2010年9月,对22例前交叉韧带损伤患者采用自制便携式下肢手术支架维持患肢体位,取腓骨长肌腱于关节镜下重建前交叉韧带。男15例,女7例;年龄19～64岁,平均33.8岁。致伤原因:交通事故伤14例,运动伤5例,摔伤3例。左膝10例,右膝12例。新鲜损伤12例,陈旧性损伤10例。前抽屉试验阳性17例,轴移试验阳性19例,Lachman试验阳性20例。术前根据国际膝关节文献委员会(IKDC)分级评定标准,异常6例,严重异常16例;IKDC主观评分为(57.64±6.11)分,Lysholm评分为(55.45±4.37)分。结果术后切口均Ⅰ期愈合,无相关并发症发生。患者术后均获随访,随访时间9～38个月,平均15个月。末次随访时无伸膝受限;屈膝活动度为120～135°,平均127°。前抽屉试验阳性1例,轴移试验阳性1例,Lachman试验阳性2例,未见明显韧带松动及韧带自发断裂等并发症发生。根据IKDC分级评定标准:正常10例,接近正常11例,异常1例;IKDC主观评分为(90.44±6.11)分,与术前比较差异有统计学意义(t=4.653,P=0.021)。Lysholm评分为(90.12±5.78)分,与术前比较差异有统计学意义(t=4.231,P=0.028)。结论应用便携式下肢手术支架辅助关节镜下前交叉韧带重建,可节省人力,便于术中操作;采用腓骨长肌腱重建前交叉韧带可以增加腱-骨接触面,有利于腱-骨愈合。

Objective To investigate the e ectiveness of portable bracket of lower limb in the reconstruction of anterior cruciate ligament（ACL） by the long bular muscle tendon under arthroscopy.Methods Between March 2008 and September 2010,22 patients with ACL injury were treated.The limb position was maintained by portable bracket of lower limb and ACL was reconstructed with the long bular muscle tendon under arthroscopy.There were 15 males and 7 females with an average age of 33.8 years（range,19-64 years）.The causes of ACL injury were tra c accident injury in 14 cases,sport trauma in 5 cases,and falling injury in 3 cases.The locations were the left knee in 10 cases and the right knee in 12 cases,including 12 fresh injuries and 10 old injuries.Of 22 patients,17 had positive anterior drawer test,19 had positive pivot shift test,and 20 had positive Lachman test.According to International Knee Documentation Committee（IKDC） criteria,there were 6 abnormal and 16 severely abnormal.The subjective IKDC score was 57.64 ± 6.11.The Lysholm score was 55.45 ± 4.37.Results All incisions healed by rst intention,and no complication was found.All patients were followed up 9-38 months（mean,15 months）.At last follow-up,the exion of the knee ranged from 120 to 135°（mean,127°）.One patient had positive anterior drawer test,1 patient had positive pivot shift test,and 2 patients had positive Lachman test.No ligament loosening and breakage occurred.According to the IKDC criteria,10 patients rated as normal,11 patients as nearly normal,and 1 patient as abnormal.The subjective IKDC score was 90.44 ± 6.11,showing signi cant di erence when compared with preoperative one（t=4.653,P=0.021）.The Lysholm score was 90.12 ± 5.78,showing significant di erence when compared with preoperative one（t=4.231,P=0.028）.Conclusion Portable bracket of lower limb in the reconstruction of ACL has the advantages of saving manpower and easy operation.The long bular muscle tendon is enough long and strong to reconstruct the ACL,which can increase the contact surface between the tendon and bone and is bene cial to tendon-bone healing.