膝关节镜辅助自体髌韧带移植重建前交叉韧带的临床应用

Reconstruction of anterior cruciate ligament using patellar tendon autograft under arthroscope

目的 探讨膝关节镜辅助自体髌韧带移植重建前交叉韧带的临床应用方法和疗效.方法 在膝关节镜辅助下采用自体骨-髌腱（中1/3）-骨复合体加挤压螺钉内固定治疗前交叉韧带损伤患者32例.结果 32例患者均获得随访,时间10～46月,平均（16.2±3.4）月.所有患者膝关节疼痛减轻或消失,无不稳及肿胀,前抽屉试验阴性,关节功能良好,未出现滑膜炎,韧带断裂、螺钉松动、关节活动明显受限等并发症.Lysholm膝关节评分由术前的（50.5±3.4）分提高到术后的（90.5±1.4）分,术后评分明显高于术前（P＜0.05）.按照改良Lysholm评分标准,本组优15例,良11例,可4例,差2例,优良率81.25%.结论 关节镜下行自体骨-髌腱-骨复合体重建前交叉韧带具有创伤小、固定牢靠、可早期康复锻炼、恢复快且疗效确切等优点,是较为理想的治疗方法.

Objective To explore the method and efficacy of anterior cruciate ligament （ACL） reconstruction with bone- patellar tendon - bone （B - PT - B） autograft under arthroscope. Methods Thirty two patients with ACL injury were treated by reconstructing ACL with bone - patellar - bone compound autograft and fixation with interference screw. Results The thirty two patients were followed up from 10 months to 46 months（ with an average of 16.2 ± 3.4 months）. The pains in the knee joints involved were decreased or disappeared in all of the cas- es. No joints instability or swell happened in all of the cases. Lachman test was negative in the knee joints in- volved. The function was excellent in the knee joints involved. The advanced Lyshdm＇s score was （50.5 ± 3.4） pre - operatively and （90.5±1. 4 ） post - operatively. The difference of the advanced Lyshdm＇ s score had statis- tical significance（ P 〈 0.05）, compared that pre - operatively with post - operatively. The knee joints stability were excellent basing on a subjective judgement in all of the cases. The outcomes were excellent in 15 cases, good in 11 cases, fair in 4 cases and poor in 2 cases according to the advanced Lyshdm＇ s classification at the last follow up. Both the excellent and good rate went up to 81 .25%. Conclusion ACL reconstruction using bone- patellar-bone compound autograft and fixation with interference screw is a good technique with little injury, firm graft fixation, early and ranid rehabilitation.