关节镜下Rigidfix交叉钉和Intrafix固定钉固定同种异体肌腱重建膝关节交叉韧带的病例对照研究

Case control study on therapeutic effects of Rigidfix cross pins combined with Intrafix pins for the reconstruction of anterior or posterior cruciate ligament under arthroscopy

目的：探讨关节镜辅助下应用Rigidfix交叉钉和Intrafix固定钉固定同种异体肌腱,重建膝关节前交叉韧带（anterior cruciate ligament,ACL）和后交叉韧带（posterior cruciate ligament,PCL）的近期临床疗效.方法：2009年1月至2010年6月在关节镜下采用异体肌腱联合应用Rigidfix交叉钉与Intrafix固定钉治疗ACL或PCL损伤34例,分为两组：ACL重建组（A组）和PCL重建组（B组）.A组24例,男19例,女5例;平均年龄（31.83±9.57）岁;在关节镜下移植同种异体肌腱重建ACL,股骨侧用Rigidfix交叉钉固定,胫骨侧用Intrafix固定钉固定.B组10例,其中男8例,女2例;平均年龄（27.20±7.59）岁;在关节镜下移植同种异体肌腱重建PCL,股骨侧用Intrafix固定钉固定,胫骨侧用Rigidfix交叉钉固定.术后即行前后抽屉试验及Lachman试验检查膝关节稳定性,并随访患者18个月以上,采用膝关节Lysholm评分和Tegner评分进行疗效评估.结果：34例均获随访,时间18～26个月,平均（20.79±2.39）个月.所有患者术后疼痛症状消失,前、后抽屉试验及Lachman试验阴性.A组术前Lysholm评分43.04±7.57,术后6、12、18个月增加至85.41±4.68、92.50±3.05和93.45±2.57;术前Tegner评分2.62±0.92,术后6、12、18个月分别增加至7.45±1.14、8.58±0.77和8.95±0.55.B组术前Lysholm评分46.20±8.27,术后6、12、18个月分别增加至86.40±5.14、90.40±2.67和92.00±3.85;术前Tegner评分2.00-0.66,术后6、12、18个月分别增加至7.10±0.99、8.60±0.84和8.80±0.42.两组患者各时间点Lysholm和Tegner评分差异均无统计学意义.所有患者术前Lysholm评分43.97±7.79,术后6、12、18个月分别增加至85.70±4.76、91.88±3.06和93.02±3.01;术前Tegner评分2.44±0.89,术后6、12、18个月分别增加至7.35±1.09、8.58±0.78和8.91±0.51.随访期间无明显排异反应及严重并发症发生.结论：关节镜下采用Rigidfix交叉钉和Intrafix固定钉固定同种异体肌腱重建膝关节交叉韧带方法简便,固定确实,重建后膝关节稳定性良好,近期疗效满意.

Objective：To evaluate therapeutic effects of Rigidfix cross pins combined with Intrafix pins for the reconstruction of anterior or posterior cruciate ligament under arthroscopy.Methods：From January 2009 to June 2010,34 patients with anterior or posterior cruciate ligament injuries were divided into two groups：group A and group B.There were 24 patients in group A,including 19 males and 5 females,with an average age of （31.83±9.57） years old.The patients in group A were treated with anterior cruciate ligament reconstruction under arthroscopy; Rigidfix cross pins and Intrafix pins were used to fix femoral and tibial side respectively.Among the 10 patients in group B,8 patients were male and 2 patients were female,with an average age of （27.20±7.59） years old.The patients in group B were treated with posterior cruciate ligament reconstruction under arthroscope ; Intrafix pins and Rigidifix cross pins were used to fix femoral and tibial side sepectively.The drawer test and Lachaman test were used to evaluate postoperative knee stability.Allthe patients were followed up at least 18 months.Lysholm and Tegner knee scores were used to evaluate the clinical therapeutic effects.Results：All the 34 patients were followed up,and the duration ranged from 18 to 26 months,with an average of （20.79±2.39） months.All the patients obtained good pain relief and knee stability.In group A,Lysholm scores significantly increased from 43.04±7.57 preoperatively to 85.41 ± 4.68,92.50±3.05,and 93.45 ±2.57 at 6,12,and 18 months postoperatively ; Tegner scores significantly increased from 2.62 ± 0.92 preoperatively to 7.45±1.14,8.58±0.77,and 8.95±0.55 at 6,12,and 18 months postoperatively.In group B,Lysholm scores significantly increased from 46.20±8.27 preoperatively to 86.40±5.14,90.40±2.67,and 92.00±3.85 at 6,12,and 18 months postoperatively;Tegner scores significantly increased from 2.00 ±0.66 preoperatively to 7.10 ±0.99,8.60 ±0.84,and 8.80±0.42 at 6,12,and 18 months postoperatively.There were no differences in Lysholm and Tegner scores between group A and B at different times during follow-up.Lysholm scores of all patients significantly increased from 43.97±7.79 preoperatively to 85.70±4.76,91.88±3.06,and 93.02±3.01 at 6,12,and 18 months postoperatively.Tegner scores of all patients significantly increased from 2.44 ±0.89 preoperatively to 7.35 ± 1.09,8.58 ±0.78,and 8.91 ±0.51 at 6,12,and 18 months postoperatively.During the follow-up period,there were no serious immunological rejection and complications.Conclusion：Reconstruction of anterior or posterior cruciate ligament under arthroscopy with Rigidfix cross pins and Intrafix pins fixation is feasible therapy for anterior or posterior cruciate ligament injuries,and the fixation is rigid.The therapy restores knee stability and provides a satisfactory short-term results.