关节镜下自体半腱肌、股薄肌肌腱保留残端重建前交叉韧带的疗效

Arthroscopic reconstruction of anterior cruciate ligament with the reserved stump of semitendinosus and gracilis tendon

目的探讨关节镜下自体半腱肌、股薄肌肌腱保留残端重建前交叉韧带(ACL)的疗效。方法在关节镜下取自体半腱肌、股薄肌肌腱保留残端重建38例ACL断裂患者。记录术后并发症、膝关节屈曲活动度,采用Lysholm评分评定临床疗效。结果患者均获得随访,时间12~20个月。术后患者均未出现切口感染、腘动脉血管损伤、下肢深静脉血栓、韧带二次断裂、关节失稳等严重合并症。术后1例下肢皮肤痛觉减退,给予营养神经等治疗5 d后逐渐恢复,考虑为术中使用止血带引起的神经损伤。Lysholm评分:术后6个月、1年明显高于术前,差异均有统计学意义(P<0.05),术后1年明显高于术后6个月,差异有统计学意义(P<0.05)。膝关节屈曲活动度末次随访时较术前明显改善,差异有统计学意义(P<0.05)。结论关节镜下自体半腱肌、股薄肌肌腱保留残端重建ACL手术破坏性小,术后可以早期愈合,功能恢复良好。

Objective To investigate the effect of anterior cruciate ligament(ACL)reconstructed with the reserved stump of semitendinosus and gracilis tendon under arthroscopy.Methods The 38 patients with ACL rupture were reconstructed with the reserved stump of semitendinosus and gracilis tendon under arthroscopy.The postoperative complications,the flexion range of knee joint were recorded.The clinical efficacy was evaluated by Lysholm score at the last follow-up.Results All patients were followed up for 12~20 months.No serious complications such as wound infection,popliteal artery injury,deep vein thrombosis,secondary ligament rupture and joint instability occurred in all patients.One case of lower limb skin pain decreased after operation,and recovered gradually after 5 d of neurotrophic therapy,who was considered as nerve injury caused by tourniquet.Lysholm score at 6,12 months postoperation was significantly higher than that of the preoperation(P<0.05),and which of the postoperative 1 year was significantly higher than that of the postoperative 6 months after operation(P<0.05).At the last follow-up,the knee flexion activity was significantly improved than that before operation(P<0.05).Conclusions The operation damage is less for arthroscopic reconstruction of ACL with the reserved stump of semitendinosus and gracilis tendon,the patient can heal in the short-term,and the function recovery is effective.