跨后纵膈入路与前方人路单束解剖重建后交叉韧带的疗效比较

Posterior trans-septum portal approach versus anterior approach for posterior cruciate ligament re-construction

目的比较跨后纵膈人路与前方人路单束解剖重建后交叉韧带（PCL）的疗效，探讨前耆的优势。方法回顾性分析2008年1月至2012年1月期间行PCL单束解剖重建的60例PCL损伤患者，根据不同时期手术入路不同分为两组：常规组28例，男17例，女11例；平均年龄为（33．0±9．4）岁；早期采用前方入路重建PCL。跨后纵膈组32例，男22例，女10例；平均年龄为（32．2±8．0）岁；后期采用跨后纵膈入路重建PCI。。比较两组患者的胫骨隧道位点距离、KT．2000值、后抽屉试验结果、神经血管损伤情况及末次随访时Lysholm膝关节功能评分和膝关节文献编制委员会（IKDC）评分等。结果常规组和跨后纵膈组患者的随访时间平均分别为（15．9±2．2）、（15．6±2．0）个月，差异无统计学意义（P〉0．05）。跨后纵膈组患者术后胫骨隧道位点距离[（2．9±1．2）mill]和KT-2000值[（2．1±1．2）mm]均小于常规组[（5．6±1．7）、（2．9±1．8）mm]，术后后抽屉试验阴性率[90．6％（29／32）]较常规组[75．0％（21／28）]高，末次随访时Lysholm膝关节功能评分和IKDC评分[（90．9±3．0）、（88．3±3．5）分]均高于常规组[（87．8±2．9）、（85．4±3．7）分]，以上项目两组间比较差异均有统计学意义（P〈0．05）。常规组2例患者出现神经血管损伤的症状，经对症处理后症状消失。结论与前方入路比较，跨后纵膈入路单束解剖重建PCL的疗效更好，可以更好地恢复膝关节的稳定性。

Objective To compare the posterior trans-septum portal approach and the anterior ap- proach for anatomic single-bundle reconstruction of the posterior cruciate ligament （PCL）. Methods We l^viewed 60 patients who had undergone anatomic single-bundle reconstruction of PCL from January 2008 to January 2012. They were divided into 2 groups according to surgical approaches used. In the conventional group, 28 patients received early PCL reconstruction via the anterior approach. They were 17 males and 11 females, with a mean age of 33.0 ±9.4 years. In the trans-septum group, 32 patients received late PCL reconstruction via the posterior trans-septum portal approach. They were 22 males and l0 females, with a mean age of 32. 2 ± 8.0 years. The 2 groups were compared in terms of tibial tunnel site distance, KT-2000 value, posterior drawer test result, neurovascular lesion, and Lysholm knee function and IKDC （International Knee Documentation Committee） scores at the last follow-up. Results The conventional and the trans-septum groups were followed up for 15.9 ± 2. 2 and 15.6 ± 2.0 months respectively, with no significant difference （P 〉 0.05） . The conventional group yielded significantly better results than the trans-septum group regarding tibial tunnel site distance, KT-2000 value, negative rate of posterior drawer test [90. 6% （29/32） versus 75.0% （21/28）], Lysholm knee function and IKDC scores （90.9 ±3.0 and 88.3 ±3.5 points versus 87.8 ±2.9 and 85.4 ±3.7 points） （ P 〈 0.05） . Two patients in the conventional group had neurovascular symptoms which responded to the treatment. Conclusion In the anatomic single-bundle reconstruction of PCL, the posterior trans-septum portal approach may result in better outcomes than the conventional anterior approach in terms of facilitating recovery of knee joint stability.