关节镜下跨后纵膈入路自体腘绳肌腱保残单束重建后交叉韧带近期疗效观察

ARTHROSCOPIC SINGLE BUNDLE POSTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING HAMSTRING TENDONS THROUGH POSTERIOR TRANS-SEPTUM PORTAL APPROACH WITH PRESERVATION OF REMNANT POSTERIOR CRUCIATE LIGAMENT FIBERS

目的 探讨关节镜下跨后纵膈入路自体腘绳肌腱保残单束重建后交叉韧带（posterior cruciate ligament,PCL）的手术方法及临床疗效。方法 2010年6月-2014年4月采用关节镜下跨后纵膈入路自体腘绳肌腱保残单束重建PCL治疗57例单纯PCL断裂患者。男41例,女16例;年龄19-42岁,平均27.7岁。均有明确外伤史。术前后抽屉试验Ⅱ度阳性9例,Ⅲ度阳性48例。受伤至手术时间2周-25个月,平均13个月。采用Lysholm评分及膝关节活动度评价手术前后膝关节功能。结果 手术均顺利完成,术中未发生血管、神经损伤等,术后切口均Ⅰ期愈合,无感染等早期并发症发生。57例均获随访,随访时间12-20个月,平均16.6个月。末次随访时伸膝活动度正常,屈膝120-130°,达到了正常运动生活活动范围。末次随访时所有患者MRI示重建韧带连续性良好并有很好的腱骨愈合;Lysholm评分较术前显著改善,差异有统计学意义（t=—27.429,P=0.000）。结论关节镜下跨后纵膈入路自体腘绳肌腱保残单束重建PCL手术操作安全简便,肌腱固定牢靠,近期效果满意。

Objective To introduce the arthroscopic single bundle posterior cruciate ligament（PCL） reconstruction using hamstring tendons through posterior trans-septum portal approach with preservation of the remnant PCL fibers, and to evaluate the clinical results. Methods Between June 2010 and April 2014, 57 patients with PCL rupture were treated with arthroscopic single bundle PCL reconstruction using hamstring tendons through posterior trans-septum portal approach with preservation of the remnant PCL fibers. There were 41 males and 16 females, aged 19-42 years（mean, 27.7 years）. All the patients had history of injury. The results of posterior drawer test were positive, including 9 cases of grade II and 48 cases of grade III. The disease duration ranged from 2 weeks to 25 months（mean, 13 months）. The Lysholm score and the range of motion of knee joint were used to evaluate the knee function. Results The operation performed smoothly, and no complications of blood vessel and nerve injuries and infection occurred. Primary healing was obtained in all incisions; no early complication occurred after operation. The patients were followed up 16.6 months on average（range, 12-20 months）. At last follow-up, the knee range of motion returned to normal in all cases（120-130° in flexion）. MRI at last follow-up showed good continuity of the PCL graft and complete healing of the remnant PCL tissues between the femoral and tibial attachments. The Lysholm score was significantly improved when compared with preoperative score（t= —27.429, P=0.000）. Conclusion Arthroscopic single bundle PCL reconstruction using hamstring tendons through posterior trans-septum portal approach with preservation of the remnant PCL fibers has the advantages of firm fixation, simple operation, and good knee function recovery.