关节镜下自体腘绳肌腱联合人工韧带一期重建膝关节多发韧带损伤26例

26 Cases Clinical Report on Arthroscopic Autogenous Hamstring Tendon Combined with Artificial Ligament One-Stage Reconstruction on the Treatment of Multiple Ligament Injuries in the Knee Joint

目的:评估关节镜下自体腘绳肌腱重建前交叉韧带(Anterior Cruciate Ligament,ACL)联合人工韧带重建后交叉韧带(Posterior Cruciate Ligament,PCL)治疗膝关节多发韧带损伤的早期临床疗效。方法:回顾性分析2017年1月至2021年1月收治并符合纳入标准的26例ACL合并PCL损伤的膝关节多发韧带损伤患者,术中关节镜下使用自体半腱肌、股薄肌重建ACL,使用人工韧带重建PCL。记录患者的手术时间、术后并发症,采用双侧胫骨前移或后移距离差值及Lysholm评分、Tegner评分、重返运动时间(Return to Sport,RTS)评价膝关节稳定性与功能。结果:26例患者均获随访,随访时间6~36个月,平均16.8个月。术后发生膝关节纤维粘连1例。至末次随访时,X线片示双侧胫骨前移距离差值((8.2±1.3)mm vs(1.3±1.2)mm)、双侧后移距离差值((8.4±1.2)mm vs(1.5±0.5)mm)、Lysholm评分((9.5±6.7)分vs(79.7±6.1)分)、Tegner评分((0.5±0.9)分vs(6.1±0.5)分)均较术前明显改善,差异有统计学意义(P<0.05)。结论:关节镜下自体腘绳肌腱重建ACL联合人工韧带重建PCL治疗膝关节多发韧带损伤的早期临床疗效满意,值得推广应用。

Objective:To evaluate the early clinical efficacy of anterior cruciate ligament(ACL)reconstruction with autogenous hamstring tendon under arthroscope combined with artificial ligament reconstruction(posterior cruciate ligament,PCL)on the treatment of multiple ligament injuries of the knee joint.Methods:A retrospective analysis of 26patients with multiple ligament injuries in the knee joint with ACL combined with PCL injury from January 2017to January 2021who met the inclusion criteria were performed.During the operation,ACL was reconstructed with autologous semitendinosus muscle and gracilis muscle under arthroscopy,and PCL was reconstructed with artificial ligament.The patient's operation time and postoperative complications were recorded,and the difference in bilateral tibial displacement distance,Lysholm score,Tegner score and return to sport(RTS)were used to evaluate the stability and function of the knee joint.Results:All 26patients were followed up from 6to 36months with 16.8months on average.One case of knee fibrous adhesion occurred after operation.By the time of the last follow-up,the X-ray showed the difference in the anterior distance of the tibia((8.2±1.3)mm vs(1.3±1.2)mm),the difference in bilateral retraction distance((8.4±1.2)mm vs(1.5±0.5)mm),Lysholm score((9.5±6.7)mm vs(79.7±6.1)mm)and Tegner score((0.5±0.9)mm vs(6.1±0.5)mm)were significantly improved compared with preoperatively,and the difference was statistically significant(P<0.05).Conclusion:Arthroscopic autogenous hamstring tendon reconstruction of ACL combined with artificial ligament reconstruction of PCL has satisfactory early clinical efficacy on the treatment of multiple ligament injuries of the knee joint and is worthy of promotion.