LARS人工韧带关节镜下一期同时重建前、后交叉韧带的近期疗效分析

Arthroscopic one-stage reconstruction of anterior and posterior cruciate ligaments with LARS artificial ligaments

目的探讨关节镜下LARS人工韧带一期重建前交叉韧带（ACL）、后交叉韧带（PCL）的近期疗效。方法回顾性分析2009年10月至2011年12月期间收治的8例ACL、PCL损伤患者资料。男7例，女1例；年龄为26～52岁，平均35．3岁。受伤至手术时间为17～21d，平均19d。术前检查及术中镜下均显示ACL、PCL完全撕裂，均应用LARS人工韧带一期同时重建。术后6个月应用国际膝关节文献委员会分级标准评定患者活动水平，末次随访时应用Lysholm膝关节评分标准评定疗效。结果本组患者的手术时间为85～102min（平均93min）。8例患者术后获6～24个月（平均12个月）随访。1例患者术后出现胫骨上段切口感染，术后4周予以清创、拧入螺钉后伤口愈合。所有患者膝关节不稳定症状消失，膝关节伸直正常，关节功能恢复良好，末次随访时屈膝活动度为100°～125°，平均108．4°。随访期间未发现韧带自发断裂、松动等症状。按国际膝关节文献委员会分级标准评定活动水平：8例患者术前均为D级，术后6个月提高到A级1例，B级7例。末次随访时Lysholm膝关节评分平均为（86．1±4．8）分，与术前【（18．7±3．1）分】比较差异有统计学意义（P〈0．05）。结论关节镜下LARS人工韧带一期同时重建ACL、PCL可以很好地恢复膝关节稳定性，且创伤小，近期疗效满意。

Objective To evaluate the efficacy of arthroscopic one-stage reconstruction of anterior and posterior cruciate ligaments with LARS artificial ligaments. Methods From October 2009 to December 2011, 8 patients with combined injury to anterior and posterior cruciate ligaments received arthroscopic one-stage reconstruction with LARS artificial ligaments. They were 7 men and one woman, aged from 26 to 52 years （average, 35.3 years）. The time from injury to operation ranged from 17 to 21 days, averaging 19 days. Pre- operative and intraoperative inspections showed complete tear of both anterior and posterior cruciate ligaments. International Knee Documentation Committee （IKDC） scoring was used at 6 months postoperation to grade the knee movement of the patients; Lysholm scoring was used at final follow-ups to evaluate the knee function. Results The operating time for this series ranged from 85 to 102 minutes （average, 93 minutes） . All the patients were followed up for 6 to 24 months （average, 12 months）. Wound infection at upper tibia occurred in one patient, which responded to debridement and screwing 4 weeks after operation. All the patients got rid of instability of the knee joint, and gained normal knee extension and fine functional recovery. At final follow-ups, the range of motion of the knee ranged from 100° to 125° （average, 108.4°）. Follow-ups revealed no breakage or loosening of the ligaments. By the IKDC scoring, of the 8 patients who had been graded all as D before opera- tion, one was improved into A and 7 into B. The Lysholm scores at final follow-ups averaged 86. 1 ± 4. 8, sig- nificantly higher than the postoperative value（ 18.7 ± 3.1） （P 〈 0. 05） . Conclusion Arthroscopic one-stage reconstruction of anterior and posterior cruciate ligaments with LARS artificial ligaments can restore the stability of knee joint and obtain satisfactory short-term results.