关节镜下应用自体腘绳肌腱保留残端解剖重建前交叉韧带的疗效

ARTHROSCOPIC ANATOMIC RECONSTRUCTION OF ANTERIOR CRUCIATE LIGAMENT WITH PRESERVATION TIBIAL REMNANT USING HAMSTRING AUTOGRAFT

目的评价保留残端应用自体胭绳肌建解剖重建前交叉韧带的临床疗效。方法选择2010年6月--2014年9月采用自体胭绳肌腱保留残端解剖重建前交叉韧带37例，其中男27例，女10例；年龄16--53岁，平均32．5岁；左膝21例；右膝16例；生活扭伤5例，运动伤13例，交通事故伤19例。损伤至手术时间1周～18个月，平均4．2个月。前抽屉试验阳性17例；Lachman试验14例；前抽屉试验和lachman试验均阳性3例。在关节镜下行单束重建在胫骨股骨附着点的中点定位，股骨端用Endobutton（施乐辉，钛合金）卡于股骨外髁，胫骨端用干预螺钉（强生，可吸收）挤压固定。术前及术后3、6、9、12个月通过国际膝关节文献委员会评分（IKDC），膝关节Lysholm评分比较膝关节功能改善情况。结果术后37例均获得随访，平均时间24．5个月（12-25个月），末次随访关节活动度110°～120°，前抽屉试验及Lachman试验均阴性；IKDC评分：术前23～46分，平均（33．4±5．4）分；术后88-97分，平均（93．2±2．1）分。Lysholm评分：术前26~48分，平均（35．4±4．4）分；术后90-96分，平均（94．2±2．8）分，术后评分均高于术前。结论自体胭绳肌腱保留残端解剖重建前交叉韧带，有利于移植物血供建立腱骨愈合、本体感觉恢复及关节稳定性。

Objective To evaluate clinical effects of arthroscopic anterior cruciate ligament anatomic recon- struction with preservation tibial remnant using hamstring autograft. Methods From June 2010 to Septem- ber 2014 ,37 patients with ACL tear were treated with preservation tibial remnant using hamstring auto- graft. There were 27 males and 10 females, aged 16~ 53 years （ averages age 32.5 years）. Twenty - one patients had injuries in the left knees, and sixteen patients had injuries in the right knees. Five patients had injuries caused by daily sprain, 13 patients had injuries caused by sports, 19 patients had injuries by traffic accident. The duration from injury to surgery was one week to eighteen months, with an average of 4.2 months. The anterior drawer test showed positive results in 17 patients. Lachman test showed positive re- sults in 14 patients. Both anterior drawer test and Lachman test showed positive results in 3 patients. Ar- throscopic single- bundle reconstruction of anterior cruciate ligament was centered within the native liga- ment＇s tibia[ insertions with independend drilling of tibial tunnels. Endobutton was used to fix the graft at the femoral, the tibial fixed by absorbable interference screw. Before operation and 3,6,9,12 months after operation, the improvement of function of the knee joint was evaluated by Lysholm score, the international Knee Documentation {IKDC）scores were observed to determinate the function of the knee. Results Thrity - seven patients were followed up , and the mean follow - up time was 24. 5 months （ ranged 12 to 25 months）. At the end of follow- up, the range of motion of all the knees was at 110 to 120 degree. There were 37 patients with negative results of anterior drawer test and Lachman test. The IKDC scores improved from preoperative 33.4 ± 5.4 （23 to 46 scores） to 93.2 ± 2. 1 （88 to 97 scores） at the follow - up time. The Lysholm scores improved from preoperative 35.4 ± 4.4 （26 to 48 scores） to 94.2 ± 2.8 （90 to 96 scores）, which all improve compared to preoperative scores. Conclusions Arthroscopic anatomic reconstruction of anterior cruciate ligament with preservation tibial remnant using hamstring autograft,which can increase the angiogenesis and enhance the tendon- bone healing of the ACL and improve the proprioception and in- crease stability of the knee.