关节镜下Transfix系统固定自体腘绳肌腱重建前交叉韧带的临床疗效

Clinical therapeutic effect of arthroscopic transfix system fixation on anterior cruciate ligament reconstruction with autologous hamstring tendon

目的观察关节镜下应用横穿钉固定（Transfix）＋界面螺钉＋门型钉固定自体腘绳肌腱重建膝关节前交叉韧带（anteriorcruciate ligament,ACL）的临床疗效。方法对本院2010年6月-2011年4月56例膝关节ACL断裂患者取自体腘绳肌腱作移植物,关节镜下应用股骨端横穿钉固定（Transfix）,胫骨端界面螺钉＋门型钉固定行ACL单束重建,通过关节活动度、前抽屉试验（anterior drawer test,ADT）、Lachman试验、轴移试验、单腿跳跃试验、Lysholm评分、国际膝关节文献委员会（International Knee Documentation Committee,IKDC）2000主观膝关节评分及膝关节动度仪KT1000对术后临床疗效进行观察。结果所有患者均获得随访,随访13~24个月（平均15.6个月）。Lysholm评分由术前（57.71±7.45）分提高到末次随访时的（92.34±3.84）分（P〈0.001）;IKDC 2000评分由术前（69.86±8.95）分提高到末次随访时的（90.23±5.14）分（P〈0.001）;膝关节动度仪KT1000由术前的（6.38±2.31）mm降低至末次随访时的（2.72±1.12）mm（P〈0.001）。结论关节镜下应用Transfix系统固定自体腘绳肌腱重建ACL近期临床疗效满意,移植物固定可靠,手术操作简单安全,术后恢复快。

Objective To observe the clinical therapeutic effect of arthroscopic transfix system ＋ interference screw ＋ spiked ligament staple fixation with autologous hamstring tendon on anterior cruciate ligament（ACL） reconstruction.Methods Fifty-six patients with ACL fragmentation admitted to our hospital from June 2010 to April 2011 underwent transfix system fixation at the femoral side,interference screw and spiked ligament staple fixation at the tibial side for single bundle ACL reconstruction with autologous hamstring tendon.Their clinical therapeutic effects were observed by knee motion test,anterior drawer test（ADT）,Lachman test,pivot shift test,one-leg hop test,Lysholm score,and International Knee Documentation Committee（IKDC） 2000 subjective knee score and knee motion KT1000 arthrometry after operation.Results The patients were followed up for 13-24 months（average 15.6 months）.Their Lysholm score and IKDC score were significantly higher after operation than before operation（92.34±3.84 vs 57.71±7.45,90.23±5.14 vs 69.86±8.95,P 0.001）,whereas their KT1000 arthrometry length was significantly shorter at the last follow-up than before operation（2.72±1.12 mm vs 6.38±2.31 mm,P 0.001）.Conclusion Arthroscopic transfix system fixation with autologous hamstring tendon is a simple procedure for ACL reconstruction with a satisfactory short-term clinical curative effect,a reliable fixation of implants,and a rapid recovery of the patients after operation.