关节镜下自体腘绳肌双股骨隧道重建后交叉韧带疗效分析

Clinical analysis of arthroscopically autologous hamstring double femur tunnel reconstruction posterior cruciate ligament

目的 对关节镜下自体腘绳肌双股骨隧道重建后交叉韧带的近期临床疗效进行观察和分析。方法选择20例后交叉韧带（posterior cruciate ligament，PCL）损伤度为3级的患者。通过自体腘绳肌腱双股骨隧道和单胫骨隧道的方法对PCL重建。术前屈膝活动度为（120.5±3.8）°。患者随访18~30个月,平均25个月。结果手术后患者屈膝的活动度为（117.3±2.7）°，相比于术前没有显著性差异（P〉0.05），没有出现伸膝受限，且侧扳试验结果都是阴性。患者术后的后抽屉试验结果为（1.3±0.5）°，Lysholm的术前评分为（50.6±7.2）分，术后评分为（93.2±2.8）分，Tegner术前评分为（1.3±0.6）分，术后评分为（6.2±0.8）分。胫骨后移术前为（11.7±1.7）mm，术后为（2.7±1.3）mm，均有显著性差异（P〈0.05）。术后患侧膝关节前后方向的松弛情况通过KT-1000进行测量，平均为（2.4±1.2）mm，15例患者〈3mm，3例患者〉5mm。结论通过自体的腘绳肌腱经双股骨隧道对PCL的后交叉韧带进行重建， PCL的前外束及后内束均得以重建，与PCL的生理解剖结构相符，可以使关节功能得到良好恢复。

Objective To observe and analyse recent efficacy of arthroscopically autologous hamstring double femur tunnel reconstruction posterior cruciate ligament. Methods 20 cases of posterior cruciate ligament trauma Ⅲ were selected. Posterior cruciate ligament was reconstructed by arthroscopically autologous hamstring double femur tunnel and single tibia. Pre-operative knee flexion was （120.5±3.8）°. Patients were followed up for 18~30 months. Results Postoperative knee flexion was （117.3±2.7）°, there was no significant difference compared with preoperative （P〉0.05）. Knee extension limited did not appear. The result of side plates test was negative. The result of postoperative drawer test was （1.3±0.5）°. Preoperative Lysholm grade was （50.6±7.2） and postoperative was （93.2±2.8）. Preoperative Tegner was （1.3±0.6） and postoperative was （6.2±0.8）. Preop-erative tibial shift was （11.7±1.7）mm and postoperative was（2.7±1.3）mm,there was significantly difference（P〈0.05）. Affected side was determined by KT-1000,the average length was （2.4±1.2）mm, the length of 15 patients was shorter than 3mm,while 3 cases was longer than 5mm. Conclusion By arthroscopically autologous hamstring double femur tunnel reconstruction poste-rior cruciate ligament, anterolateral beams and posteromedial beams of PCL were constructed, and were consistent with physio-logical and anatomical structure of PCL, joint function get good recovery.