关节镜下规避板股韧带损伤重建后交叉韧带的临床疗效

Clinical effect of posterior cruciate ligament reconstruction after avoiding meniscofemoral ligaments injury under arthroscope

目的探讨经后内侧入路关节镜下规避板股韧带(meniscofemoral ligaments,MFLs)损伤重建后交叉韧带(posterior cruciate ligament,PCL)的临床疗效。方法回顾分析2016年7月-2020年5月符合标准的40例患者应用自体腘绳肌腱在关节镜下规避MFLs重建PCL。其中20例为保留MFLs组,单纯PCL断裂,MFLs完整;20例为非保留MFLs组,患者无MFLs、MFLs断裂或为显露手术视野切除MFLs。两组病人性别、年龄、术后随访时间差异均无统计学意义。胫骨隧道定位在PCL胫骨止点外侧关节面下方1.5cm,PCL后内侧束(posteromedial bundle,PMB)足印区。股骨隧道经前外侧入路定位于股骨内侧髁(右1点或左11点)关节软骨后方0.5 cm,PCL前外侧束(anterolateral bundle,ALB)足印区。取自体腘绳肌腱作为移植物,股骨侧用Endobutton悬吊固定,胫骨侧用界面螺钉固定。术后进行随访,了解膝关节功能恢复情况。结果40例患者随访(28.10±5.70)月。患者无屈伸膝关节受限,40例患者后抽屉试验阴性。Lysholm膝关节功能评分和国际膝关节评分委员会(international knee documentation committee,IKDC)主观功能评分,组内术前与术后相比较差异有统计学意义(P<0.05),术后组间比较,差异有统计学意义(P<0.05)。结论经后内侧入路关节镜下规避MFLs损伤重建PCL,镜下视野清楚、无盲区,操作安全,韧带的胫骨止点定位准确,同时符合生物学和生物力学,短期疗效肯定。

Objective:To investigate the Clinical effect of posterior cruciate ligament reconstruction after avoiding meniscofemoral ligaments injury under arthroscope by posterior medial approach.Methods:Retrospective analysis was performed on 40 cases who met the criteria from July 2016 to May 2020.PCL reconstruction was performed with autologous hamstring tendon under arthroscopy to circumvent MFLs.Among them,20 cases were in the reserved MFLs group,with PCL rupture only and the MFLs intact.Other 20 cases were in the group without MFLs or MFLs ruptured or MFLs resected for exposing surgical field.There were no significant differences in gender,age and postoperative follow-up time between the two groups.The tibial tunnel was located in the footprint area of the posteromedial bundle(PMB)1.5 cm below the articular surface of the lateral tibial insertion of PCL.The femoral tunnel was located in the footprint area of anterolateral bundle(ALB)of PCL at 0.5 cm posterior to the articular cartilage of the medial femoral condyle through an anterolateral approach.The graft was taken from the hamstring tendon,which femoral side was suspended with Endobutton,and the tibial side was fixed with interfacial screw.Postoperative follow-up was conducted to understand the recovery of knee function.Results:Forty cases were followup for 28.10±5.70 months.There was no limitation of flexion and extension of the knee,and the posterior drawer test was negative in 40 patients.Lysholm Knee function score and International Knee Documentation Committee(IKDC)subjective function score within the group showed statistically significant differences before and after operation(P<0.05).The difference in different groups was statistically significant(P<0.05).Conclusion:The reconstruction of PCL after avoiding MFLs injury under arthroscope by posterior medial approach has clear field of vision,no blind area,safe operation and accurate positioning of tibial insertion of ligament,which conforms to biology and biomechanics,and has positive short-term efficacy.