保留并牵张缝合Rigidfix固定胫骨残迹的前交叉韧带重建

Clinical effects of anterior cruciate ligament reconstruction with tibial remnants preservation

目的探讨关节镜下保留并牵张缝合固定胫骨残迹的前交叉韧带(ACL)重建方法,评估其临床效果。方法自2006年10月～2008年12月经关节镜下确诊ACL断裂,胫骨附丽处有残存纤维瘢痕组织79例(79膝)患者,采用保留残迹自体腘绳肌腱单束重建ACL,术中对原ACL残迹不做切除,分离、梳理其近端,用PDS线穿缝;将缝线经股骨道从Rigidfix横孔拉出以维持张力,打入横钉固定。术后随访30～37个月,平均32个月,依Daniel单腿水平跳跃试验、IKDC和Lysholm膝关节评分标准评价疗效。结果所有患者均获随访,2例出现小腿肌支血栓,抗凝治愈;1例切口浅层感染,引流抗炎治愈;1例出现关节纤维化,通过麻醉下手法松解康复。终末随访时稳定性检查:所有患者轴移试验阴性,4例前抽屉试验Ⅰ°不稳,LachmantestⅠ°阳性15例,Ⅱ°松弛2例。KT2000检查显示膝关节前向松弛度术后差值平均为(5.2±2.4)mm,术前为(10.1±2.7)mm,手术前后有统计学差异(t=6.835,P<0.05)。关节活动度:7例伸膝滞缺5°,9例屈膝欠缺5°,有10°屈膝欠缺2例。Daniel单腿水平跳跃试验53例(67%)为正常,23例(29%)接近正常,3例异常。综合分析:Lysholm评分术前为(63.27±6.74)分,术后为(91.36±3.72分),手术前后有统计学差异(t=7.354,P<0.05);24例(30%)IKDC评级正常,53例(67%)为接近正常,2例异常。结论本方法能最大程度地保留、并发挥ACL胫骨残端可能的功用,且可避免其发生髁间窝撞击;并能建立稳定的膝关节取得满意的临床疗效。

Objective To evaluate the technique and outcome of arthroscopic reconstruction of anterior cruciate ligament （ACL） with tibial remnants preservation. Methods From October 2006 to December 2008, 79 cases of ACL rupture were treated with single-bundle ACL reconstruction in which the ligament remnants were preserved. The tibial remnants were preserved as much as possible, and were separated and sutured with polydioxanone monofilament synthetic absorbable sutures （PDS）. The PDS sutures were extruded through the cross-drilled hole and fixed with Rigid Fix. The effect was evaluated by Daniel tests, IKDC and Lysholm score system. Results All the patients were followed up for 30 - 37 months, 32 months in average. All the patients had negative results in pivot shift test. At the final follow- up, four patients had I° unstability in anterior drawer test. The positive Lachman test results was 1 o in 15 patients and I° in two patients. The anterior laxity was （10. 1±2. 7） before operation and （5.2±2.4） at final follow-up （ t = 6. 835, P 〈 0. 05 ）. Seven patients had 5° of extension deficiency in knee. Nine patients had 5° of flexion deficiency in knee and two patients had 10° of flexion deficiency. Daniel test results were normal in 53 patients, approximately normal in 23 patients and abnormal in three patients.Lysholm scores was （ 63.27± 6. 74 ） before operation IKDC results were normal in 24 patients, approximately Conclusions The function of ACL tibia remnant reconstruction with remants preservation. This kind impingement and it may have good clinical effects. and （91.36±3.72） after surgery （P〈0.05）. normal in 53 patients and abnormal in two patients. can be preserved as much as possible by the of operation can avoid the intercondylar fossa impingement and it may have good clinical effects.