膝关节镜下自体髌韧带重建前交叉韧带手术探讨

ARTHROSCOPIC RECONSTRUCTION OF ANTERIOR CRUCIATED LIGAMENT BY USING AUTOLOGOUS BONE-PATELLA TENDON-BONE

目的 :报告关节镜下采用中 1 / 3骨 -髌韧带 -骨 (BPTB)等长重建前交叉韧带手术 1 0例 ,并对临床疗效进行分析讨论。方法 :经临床及关节镜检查确诊的前交叉韧带 (ACL)损伤患者 1 0例 ,平均年龄 2 2 .3岁 (1 7～2 6岁 ) ,取自体BPTB中 1 / 3 ,关节镜下重建其ACL。术后随访时间 1 6个月 (1 2～ 2 0个月 ) ,参照敖英芳临床判断标准及lysholm评分评价疗效。结果 :临床效果优者 3例 ,良 5例 ,中 1例 ,差 1例。Lysholm评分术前(2 3 .8± 8.53)分 ,术后 (88± 7.48)分 (P <0 .0 1 )。术后 3例合并膝前疼痛 ,其中 2例接受再次关节镜手术 ,再次镜检证实为脂肪垫挤压综合征 ,均于手术后恢复。结论 :膝关节镜下自体髌韧带重建前交叉韧带 ,近期疗效肯定 ,术后恢复快 。

Objective:To report the method of arthroscopic reconstruction of anterior cruciated ligament (ACL) by using mid one-third of bone-patella tendon-bone (BPTB) and to evaluate the clinical results. Methods:Ten patients with rupture of ACLs were diagnosed by clinical and arthroscopic examination. They were 6 males and 4 females with an average age of 22.3yrs (17～26yrs). All were operated upon arthroscopically by using autologous mid one-third of BPTB. Each end of the graft was fixed to a screw in the femur or in the tibia near the tunnel. Plaster splints were used for four weeks after operation.Results:Patients were followed up averagely for 16 (12～20) months. Excellent or good results were observed in 8 patients (80%).Lysholm knee scores were 23.8 ± 8.53 preoperatively and 88±7.48 postoperatively ( P <0.01). Three patients had anterior patellar pain. Among them 2 were accepted arthroscopic examination again and demonstrated that the reason was fatpad crushed.Conclusions:Arthroscopic reconstruction of ACL with autologous mid one-third BPTB may be one of the excellent methods bringing less injuries, and how to prevent anterior knee pain worthy of clinical evaluation.