由后向前建立胫骨隧道的全内后交叉韧带重建治疗后交叉韧带损伤的近期疗效

Establishment of tibial tunnel via a posterior-anterior approach for all-inside posterior cruciate ligament reconstruction:short-term outcomes

目的探讨由后向前建立胫骨隧道的全内后交叉韧带(PCL)重建技术治疗PCL损伤的近期疗效。方法回顾性分析2017年1月至2018年1月期间浙江省人民医院骨科治疗的15例(15膝)PCL损伤患者资料。男9例,女6例;平均年龄为46.3岁(23~60岁);左膝8例,右膝7例;平均受伤至手术时间33.6d(4~120d)。合并伤:内侧半月板损伤3例,外侧半月板损伤1例,内侧副韧带损伤2例,外侧副韧带损伤1例。术前查体及MRI检测均显示PCL完全断裂,均采用由后向前建立胫骨隧道的PCL重建技术治疗。手术前、后均采用Lysholm膝关节功能评分和国际膝关节文献委员会(IKDC)膝关节功能主观评分进行评定。结果15例患者术后获平均8.3个月(6~12个月)随访。手术时间平均为55min(45~70min)。所有患者术后膝关节不稳症状均消失,后抽屉试验和胫骨后沉征均呈阴性,末次随访时膝关节屈曲活动度达到110°~130°,平均118°。末次随访时IKDC膝关节主观评分为(88.1±3.3)分,与术前[(52.3±2.1)分]相比差异有统计学意义(P<0.05);膝关节Lysholm评分为(90.6±3.1)分,与术前[(43.1±2.3)分]相比差异有统计学意义(P<0.05)。结论由后向前建立胫骨隧道的全内PCL重建技术,无需定位器、倒打钻等特殊工具即可完成全内PCL重建手术,术中可获得良好的PCL足印区视野,胫骨隧道内口定位准确,有效避免了血管、神经损伤,操作方便,术后近期疗效良好。

Objective To introduce a new posterior-anterior approach used to establish tibial tunnel for all-inside posterior cruciate ligament (PCL) reconstruction and evaluate its short-term therapeutic effects.MethodsWe retrospectively analysed the 15 patients (15 knees) with PCL injury who had been treated at Department of Orthopaedics, Zhejiang Provincial People's Hospital from January 2017 to January 2018. They were 9 men and 6 women, with a mean age of 46.3 years (from 23 to 60 years). Of them, 8 left and 7 right sides were injured. The intervals from injury to surgery averaged 33.6 days (from 4 to 120 days). Their injury was complicated with medial meniscus tear in 3 cases, lateral meniscus tear in one case, lesion of medial col-lateral ligament in 2 cases and lesion of lateral medial collateral ligament in one case. After preoperative physical examination and MRI confirmed complete PLC tear in all of them, they were treated by arthroscopic all-inside PCL reconstruction in which a new posterior-anterior approach was used to establish the tibial tunnel. Lysholm scoring and International Knee Documentation Committee (IKDC) scoring were used preoperatively and postop-eratively to evaluate the knee functions.ResultsTheir follow-ups averaged 8.3 months (from 6 to 12 months). Operation time averaged 55 minutes (from 45 to 70 minutes). All the patients got rid of the knee instability after surgery. All their posterior drawer tests and sag signs turned to be negative. At the final fol-low-up, their range of motion of the knee ranged from 110° to 130° (average, 118°);their average IKDC score was 88.1±3.3 (from 82 to 93), significantly higher than the preoperative value (52.3±2.1) (P<0.05);their average Lysholm score was 90.6±3.1 (from 84 to 96), significantly higher than the preoperative value (43.1±2.3) (P<0.05).ConclusionsThis new method can avoid neurovascular damage and overcome the killer turn because it provides adequate exposure of the tibial PCL footprint and accurate placement of the tibial tunnel. It is also very convenient because the new posterior-anterior approach can be used to establish the tibial tunnel in all-inside PCL reconstruction without special tools like tibial PCL guide and retrograde drill. Its short-term clinical results have proved to be satisfactory.