关节镜下保留残端四股腘绳肌腱单束重建后交叉韧带疗效观察

EFFECTIVENESS OF ARTHROSCOPIC SINGLE-BUNDLE POSTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH REMNANT PRESERVATION AND QUADRUPLED HAMSTRING TENDONS

目的探讨关节镜下保留残端4股腘绳肌腱单束重建后交叉韧带(posterior cruciate ligament,PCL)的方法及疗效。方法回顾分析2007年10月-2012年8月收治并获随访1年以上的32例PCL断裂患者临床资料。男24例,女8例;年龄20～53岁,平均35.6岁。致伤原因:交通事故伤21例,运动伤8例,高处坠落伤3例。病程1周～2年,中位病程6.3周。单纯PCL断裂9例;复合韧带损伤23例,其中合并前交叉韧带断裂10例,后外侧复合体损伤11例,后内侧复合体损伤2例。膝关节功能Lysholm评分为(53.8±7.1)分,根据国际膝关节文献委员会(IKDC)评级标准,C级10例、D级22例。取同侧自体腘绳肌腱于关节镜下重建PCL,股骨端纽扣钢板悬吊固定,胫骨端生物界面螺钉固定,清理残端漂浮物,保留结构稳定的连续性韧带残端。结果术后切口均Ⅰ期愈合,无早期并发症发生。32例均获随访,随访时间12～36个月,平均23.4个月。术后患者膝关节不稳症状均消失,胫骨结节塌陷征及后抽屉试验、Lachman试验均为阴性。末次随访时,膝关节活动度均恢复至正常范围。Lysholm评分为(92.3±2.0)分,较术前显著提高,差异有统计学意义(t=—34.32,P=0.00)。根据IKDC评级标准,A级26例、B级6例,与术前比较差异有统计学意义(Z=—5.57,P=0.00)。结论关节镜下保留残端4股腘绳肌腱单束重建PCL具有操作简便、创伤小的优点,术后膝关节功能恢复良好。

Objective To investigate the effectiveness of posterior cruciate ligament （PCL） reconstruction with remnant preservation and autogenous quadrupled hamstring tendons under arthroscopy. Methods Between October 2007 and August 2012, 32 patients with PCL rupture were treated and followed up for more than 1 year. There were 24 males and 8 females, aged 20-53 years （mean, 35.6 years）. The causes of injury included traffic accident injury in 21 cases, sports injury in 8 cases, and falling injury from height in 3 cases. The disease duration ranged 1 week to 2 years （median, 6.3 weeks）. Nine patients had simple PCL rupture, 23 patients complicated by ligament injury, including 10 cases of anterior cruciate ligament rupture, 11 cases of posterolateral corner injury, and 2 cases of posteromedial corner injury. Preoperative Lysholm score was 53.8 ± 7.1. According to the International Knee Documentation Committee （IKDC） rating criteria, 10 cases were classified as grade C and 22 cases as grade D. PCL was reconstructed with autogenous quadrupled hamstring tendons, the tendons were fixed with EndoButton at the femoral side and with interference screw at the tibial side; floats of stump were cleaned up, and the structural stability and continuity ligament remnants were preserved. Results Primary healing was obtained in all incisions; no early complication occurred after operation. Thirty-two patients were followed up 23.4 months on average （range, 12-36 months）. All patients had no symptom of knee instability; the results of tibia sags sign, posterior drawer test, and Lachman test were negative. At last follow-up, the knee range of motion （ROM） returned to normal in all cases. The Lysholm score was 92.3 ± 2.0, showing significant difference when compared with preoperative score （t=- -34.32, P=0.00）. According to the IKDC rating criteria, 26 cases were classified as grade A and 6 cases as grade B at last follow-up, showing significant difference when compared with preoperative grade （Z-- -5.57, P=0.00）. Conclusion Arthroscopic single-bundle reconstruction of PCL with remnant preservation and quadrupled hamstring tendons has advantages of minimal trauma, simple operation, and good knee function recovery.