关节镜下保留胫骨残端纤维同种异体肌腱移植重建前交叉韧带

Arthroscopic anterior cruciate ligament reconstruction with remnant preserving technique

目的:探讨关节镜下保留胫骨残端纤维同种异体肌腱移植重建前交叉韧带的方法及疗效。方法:2008年5月至2010年10月,采用保留胫骨残端纤维重建ACL68例,男33例,女35例;平均年龄25.8岁(17～43岁);受伤至手术时间3～6个月,平均(4.5±1.1)个月。术前轴移试验阳性55例,Lachman试验阳性68例,前抽屉试验阳性68例。KT2000仪器测量胫骨前移度,与对侧肢体相比,相差值为(7.2±2.3)mm(5～9mm)。Lysholm评分45～67分,平均55.7±5.4,优0例,良0例,中3例,差65例;Tegner运动功能评分2～4分,平均3.1±0.6。结果:术后均获随访,时间24～42个月,平均(31.5±2.4)个月。终末随访时膝关节轴移阴性68例;Lachman试验阴性60例,I度阳性8例;前抽屉试验阴性58例,Ⅰ度阳性6例,Ⅱ度阳性4例;KT2000测量胫骨前移度,终末随访时比健侧增加(1.9±0.7)mm(0～3mm),与术前比较,差异有统计学意义(t=21.15,P=0.0001)。Lysholm评分81～97分,平均86.0±5.1,与术前比较,差异有统计学意义(t=18.55,P=0.0010);Lysholm评分优55例,良10例,中3例,差0例,与术前比较,差异有统计学意义(Z=-3.066,P<0.05)。Tegner运动功能评分6～9分,平均7.8±0.3,与术前比较,差异有统计学意义(t=9.11,P=0.0005)。结论:保留残端纤维采用异体肌腱重建ACL可增加移植物的血供和神经支配,促进腱骨愈合,有利于移植物重塑,短期随访疗效良好。

Objective ： To evaluate the clinical outcome of arthroscopic reconstruction of anterior cruciate ligament （ACL） with remnant preserving technique. Methods：From May 2008 to October 2010,68 patients with ACL deficiency （33 males and 35 females, with an average age of 25.8 years, ranged from 17 to 43 years ） were treated with arthroscopy. The average duration of the disease was （4.5± 1.1 ） months. The pivot shift test showed positive results in 55 cases, Lachman test showed positive results in 68 cases ,and the ADT （anterior drawer test） showed positive results in 68 cases. The anterior transition of the tibia measured by KT2000 instrument was （7.2±2.3） mm （5 to 9 mm） more than that of the opposite knee. The average Lysholm score was 55.7±5.4 （45 to 67）. The average Tegner activity scores was 3.1±0.6 （2 to 4）. The tibial tunnels and femoral tunnels were drilled in the middle of the footprint of the ACL,and the graft was wrapped by the remnant. Grafts were fixed with cross pin at the femoral side and with biodegradable interference screw at the tibial side. Postoperative symptoms and signs were observed in the follow-up du- ration. The anterior transition of the tibia was measured by KT2000 ,the Lysholm and Tegner scores were used to evaluate knee functions. Results ： All the patients were followed up, and the duration ranged from 24 to 42 months, with a mean of （31.5±2.4） months. At the latest follow-up ,there was no patients had positive result by civot shift test,while the Lachman test showed results of negative or positive of grade Ⅰ , and the ADT test showed results of negative or positive of grade Ⅰ or Ⅱ. The anterior transition of the tibia measured by KT2000 instrument decreased to （1.9±0.7） mm （0 to 3 mm） more than that of the opposite knee（t=21.15, P=0.000 1 ）. The postoperative Lysholm score 86.0±5.1 （81 to 97 ） and Tegner score 7.8±0.3 （6 to 9 ） all increased compared with preoperative 55.7±5.4 and 3.1±0.6 （t=18.55, P=0.001 0; t=9.11 ,P=0.000 5 ）. According to Lysholm score, excellent results were obtained in 55 cases, good in 10, poor in 3 and no bad results. Conclusion： The ACL remnant provide vascular and nerve supply for the graft, promoting union and remodeling of grafts.