关节镜下单一移植物同时重建前交叉韧带及前外侧韧带

Arthroscopic simultaneous reconstruction of anterior cruciate ligament and anterolateral ligament with a single graft through the penetrated femoral tunnel

[目的]探讨关节镜下单一移植物同时重建前交叉韧带(ACL)及前外侧韧带(ALL)的手术技术,并对其早期临床疗效进行评估。[方法]2015年10月~2017年1月,12例前交叉韧带断裂合并Segond骨折或前交叉韧带重建术后再断裂患者接受本术式治疗,所有患者麻醉下检查轴移试验2+或3+。关节镜下分别建立骨隧道,特别是贯通ACL关节内止点与ALL关节外止点的股骨隧道,将由自体半腱肌、股薄肌及腓骨长肌腱编织五股而成的单一移植物导入骨隧道,同时重建ACL和ALL。采用Lysholm主观功能评分及轴移试验评价临床结果。[结果]本组术后早期均未发生严重并发症。术后随访6~18个月,平均10.92个月,术后伸直位无膝关节不稳;轴移试验10例阴性,2例Ⅰ度阳性;Lysholm主观功能评分由术前(69.35±7.62)分增加至末次随访时(93.91±5.27)分,两时间点间差异有统计学意义(t=15.471,P<0.001)。[结论]关节镜下单一移植物同时重建前交叉韧带(ACL)及前外侧韧带(ALL)技术简便可行,可有效恢复膝关节前向及旋转稳定性。

[Objective] To explore the surgical technique of arthroscopic combined reconstruction of anterior cruciate ligament （ACL） and anterolateral ligament （ALL） with a single graft through a penetrated femoral tunnel, and evaluate the clinical outcome. [Methods] From October 2015 to January 2017, 12 patients with ACL tear accompanied with Segond fracture or failure of primary ACL reconstructionunderwent this surgical treatment. All the patients had 2＋ or 3＋ grade of pivot-shift phenome- na under anesthesia. Arthroscopically bone tunnels, especially the penetrated femoral tunnel aimed at the intraarticular inser- tion of ACL and the extraarticular insertion of ALL, were respectively created outside-in. A single tendon graft made of 5 strands of autologous semitendinosus, gracilis and peroneus longus tendon was introduced into the bone tunnels to reconstruct the ACL and ALL simultaneously. The Lysholm score and pivot-shift test were used to evaluate the clinical outcome. [Results] No severe complications occurred in any of the 12 patient at early stage after operation. All of the patients were followed up for 6 to 18 months with an average of 10.9 months. No any patients complained about knee unstable symptoms during the follow- up. At the latest follow-up, 10 patients presented the negative pivot-shifttest, while the remaining 2 patients had 1 ＋ grade of the rotational laxity. Furthermore, the Lysholm score significantly improved from （69.35±7.62） preoperatively to （93.91±5.27） at the latest follow up （t=15.471, P〈0.001）. [Conclusion] This arthroscopic simultaneous reconstruction of ACL and ALL with a single graft through the penetrated femoral tunnel is an easy and feasible technique with reliable restoration of the anterior and rotational knee stability.