关节镜下应用自体腘绳肌腱重建前交叉韧带的临床分析

Effects of anterior cruciate ligament reconstruction using autologous hamstring tendon by arthroscope

目的探讨自体股薄肌及半腱肌重建前交叉韧带(ACL)的临床疗效。方法研究应用自体股薄肌、半腱肌移植重建前交叉韧带损伤病例共30例。术后追踪随访进行为期2年的康复训练,术前和术后随访时行患肢X线检查、功能评分。结果本组病例均获得随访,时间平均32个月(24～40个月),术后Lachman征及旋转移位试验阴性。Lysholm评分由术前平均(54.80±2.10)分增加至术后2年为(91.00±2.30)分,两者之间的差异有统计学意义(t=61.930,P<0.01)。而Tegner评分则由术前平均(5.00±1.20)分增加至术后2年(6.23±1.40)分,两者之间的差异有统计学意义(t=3.650,P<0.01)。手术前后X线复查无退行性改变。结论自体腘绳肌腱重建ACL术后2年随访发现患者膝关节前向不稳消失,膝关节功能评分比术前明显增加。用该方法重建ACL能有效恢复膝关节的功能。

Objective To investigate the clinical efficacy of reconstruction of the anterior cruciate ligament （ACL） by using the tendon of gracilis and semitendinosus. Methods 30 cases were adopted to study the gracilis and semitendinosus tendon graft reconstructing the anterior cruciate ligament. Postoperative follow-up and rehabilitation were carried out for two years. Before operation and during the postoperative follow-up, the x-ray examination and function of the affected limb were evaluated. Results All patients were followed up for an average time of 32 months （24 to 40 months ）. The postoperative Lachman sign and rotational displacement test were negative. Lysholm score increased from an average of （54. 8 ± 2. 1 ） to （91. 0 ± 2. 3） points at the last follow-up （ t = 61. 930, P 〈 0. 01 ）. The Tegner score increased from an average of （ 5.0 ± 1. 2 ） preoperatively to （ 6.23 ±1.4 ） points postoperatively （ t = 3. 650, P 〈 0.01 ）. Preoperative and postoperative x-ray inspections showed no degenerative changes. Conclusions The 2-year follow-up results indicate that the anterior instability disappears after patients undergo the hamstring tendon reconstruction. Knee function scores may increase significantly comparing with preoperative ones. ACL reconstruction using this method can effectively restore the function of the knee joint.