关节镜下解剖止点中点单束重建前交叉韧带的近期疗效

SHORT-TERM EFFECTIVENESS OF ARTHROSCOPIC SINGLE-BUNDLE RECONSTRUCTION OF ANTERIOR CRUCIATE LIGAMENT BEING CENTERED WITHIN NATIVE LIGAMENT'S TIBIAL AND FEMORAL INSERTIONS

目的总结关节镜下经胫骨、股骨独立隧道，解剖止点中点单束重建前交叉韧带（anterior cruciate ligament，ACL）的近期疗效。 方法2008年9月－2010年9月，收治33例陈旧性ACL断裂患者。男19例，女14例；年龄22～33岁，平均26.4岁。致伤原因：交通事故伤15例，摔伤13例，运动伤5例。左膝20例，右膝13例。损伤至手术时间为2～20个月，平均6个月。在关节镜下行单束重建，通过胫骨、股骨独立隧道，将自体肌腱移植物定位于胫骨、股骨止点的中点并固定。应用Lachman试验、轴移试验及KT-1000关节测量仪评估膝关节稳定性，按照国际膝关节文献委员会（IKDC）评分标准、Lysholm评分评价膝关节功能。 结果 术后切口均Ⅰ期愈合，无关节内感染、下肢深静脉血栓形成和血管、神经损伤等并发症发生。术后患者均获随访，随访时间13～24个月，平均18.6个月。术后1年，Lachman试验阴性31例、Ⅰ度阳性2例，与术前Ⅰ度阳性4例、Ⅱ度26例、Ⅲ度3例比较，差异有统计学意义（Z= —5.42，P=0.00）；轴移试验阴性31例、Ⅰ度阳性2例，与术前Ⅰ度阳性15例、Ⅱ度18例比较，差异有统计学意义（Z= —5.17，P=0.00）。KT-1000关节测量仪检查屈膝25°、134 N前向拉力时双侧膝关节前向松弛度差值为（1.2 ± 0.7） mm，屈膝70°、134 N前向拉力时为（0.8 ± 0.6） mm，与术前（7.8 ± 2.1） 、（5.0 ± 1.8） mm比较，差异均有统计学意义（t=16.19，P=0.00；t=13.28，P=0.00）。IKDC膝关节功能评分为（95.1 ± 1.6）分，Lysholm评分为（92.0 ± 2.5）分，与术前（39.6 ± 4.5）、（48.3 ± 3.6）分比较，差异均有统计学意义（t= —78.88，P=0.00；t= —42.00，P=0.00）。 结论关节镜下利用胫骨、股骨独立隧道，解剖止点中点单束重建ACL可恢复膝关节稳定性，近期疗效较好。

ObjectiveTo evaluate the short-term effectiveness of arthroscopic single-bundle reconstruction of anterior cruciate ligament （ACL） being centered within the native ligament’s tibial and femoral insertions with independent drilling of tibial and femoral tunnels. MethodsBetween September 2008 and September 2010, 33 patients with chronic ACL ruptures underwent arthroscopic reconstruction with four-stranded hamstring tendons in single-bundle. There were 19 males and 14 females, aged 22-33 years （mean, 26.4 years）. Injuries were caused by traffic accident in 15 cases, by falling in 13 cases, and by sports in 5 cases. The location was the left knee in 20 cases and the right knee in 13 cases. The average time from injury to surgery was 6 months （range, 2-20 months）. ACL reconstruction could be optimized when single-bundle grafts were centered within the native ligament’s tibial and femoral insertions with independent drilling of tibial and femoral tunnels. KT-1000 test, Lachman test, and pivot-shift test were used to evaluate the knee stability, and the International Knee Documentation Committee （IKDC） and Lysholm scores to assess the knee function. ResultsPrimary healing of incision was obtained in all patients, who had no complications of intra-articular infection, deep venous thrombosis of the lower extremity, and injury of blood vessels and nerves. All the patients were followed up 18.6 months on average （range, 13-24 months）. At 1 year after operation, the results of Lachman test were negative in 31 cases and I degree positive in 2 cases, showing significant difference when compared with preoperative results （I degree positive in 4, II degree positive in 26, and III degree positive in 3） （Z= —5.42, P=0.00）. The results of pivot-shift test were negative in 31 cases, I degree positive in 2 cases, showing significant difference when compared with preoperative results （I degree positive in 15 and II degree positive in 18） （Z= —5.17, P=0.00）. The KT-1000 results of examination （134 N） showed that the side difference of anterior laxity was （1.2 ± 0.7） mm at 25° flexion and （0.8 ± 0.6） mm at 70° flexion, showing significant differences when compared with preoperative ones [（7.8 ± 2.1） mm and （5.0 ± 1.8） mm] （t=16.19, P=0.00; t=13.28, P=0.00）. The IKDC score was significantly increased from 39.6 ± 4.5 at preoperation to 95.1 ± 1.6 at postoperation （t= —78.88, P=0.00）, and Lysholm score was significantly increased from 48.3 ± 3.6 at preoperation to 92.0 ± 2.5 at postoperation （t= —42.00, P=0.00）. ConclusionIt is a reliable procedure to restore the stability of the knee that arthroscopic single-bundle reconstruction of ACL is centered within the native ligament’s tibial and femoral insertions with independent drilling of tibial and femoral tunnels.