关节镜下膝关节后交叉韧带双束重建疗效观察

Observation on the effect of double-Bundle transtibial posterior cruciate ligament reconstruction with a tenendon autograft

目的 探讨关节镜下半腱肌腱联合髌骨韧带双束重建膝关节后交叉韧带临床疗效。方法 对后交叉韧带（PCL）断裂患者采用关节镜下半腱肌腱联合髌骨韧带双束重建治疗13例,观察术后膝关节活动度、关节功能、临床疗效;分析X片胫骨平台后移情况。结果 IKDC评分：术前7例C级,6例D级;术后3例A级,8例B级,2例C级,手术前后差异有统计学意义（P〈0.05）;Lysholm评分：术前（58±5.10）分,术后（89.5±4.8）分;胫骨平台X片分析：术前（14.6±3.4）mm,术后（14.6±3.4）mm。手术前后比较均差异有统计学意义（P〈0.05）。结论 半腱肌腱联合髌骨韧带双束重建膝关节后交叉韧带可以纠正平台后移,显著改善患膝症状,相比单束重建临床效果更理想。

Objective To evaluate the clinical effect and outcomes after arthroscopic-assisted double-bundle posterior cruciate ligament （PCL） reconstruction.Methods 13 patients with grade III isolated chronic PCL tears underwent double-bundle PCL reconstruction were enrolled in this study.Range of joint motion,knee function and stress radiographs were observed to evaluate the clinical outcome.Results Postoperative physical examination revealed a reduction of the posterior drawer and tibial step-off in all cases.According to International Knee Documentation Committee score,before operation,7 cases were grade C,6 cases were grade D.After operation,3 cases of grade A,8 cases of grade B,2 cases of grade C.There were significant differences （P〈0.05）.By the Lysholm knee scoring scale,after operation the score was （89.5±4.8）,which was higher than （58.0±5.1） before treatment.The postoperative stress radiographs revealed posterior instability of （14.6±3.4）mm before operation,compared with （4.7±2.4）mm after operation,there was significant difference（P〈0.05）.Conclusion The technique of double-bundle PCL reconstruction produced a significant reduction in knee symptoms and allowed the patients to return to moderate or strenuous activity,although the posterior tibial translation was not completely normalized and our results appear to be no better than the results of single-bundle PCL reconstruction.