关节镜下股四头肌腱双束重建后交叉韧带

Arthroscopic double-bundle posterior cruciate ligament reconstruction using quadriceps tendon-patellar bone autograft

目的 介绍一种新的后交叉韧带重建手术方法及早期临床疗效。 方法 对 2 0例后交叉韧带损伤病例采用关节镜下前外束及后内束双束重建术。选择一端带骨块的自体股四头肌腱并制备“Y”形双束移植物 ,股骨侧双隧道 ,胫骨侧单隧道。分别在伸膝及屈膝 90°位拉紧固定双束。同时或分次处理复合韧带损伤。 结果 2 0例均得到随访 ,随访期 6～ 12个月 ,平均 7 5个月。其中单纯后交叉韧带 8例 ,均为Ⅱ°及Ⅲ°损伤。复合损伤 12例。新鲜伤 5例 ,陈旧伤 15例。主观评分示 :Lyshlom评分优者 5例 ( 2 5 %) ,良 14例 ( 70 %) ,差 1例 ( 5 %) ;IKDC评分A级 1例 ( 5 %) ,B级 16例( 80 %) ,C级 2例 ( 10 %) ,D级 1例 ( 5 %)。客观评分 :KT 10 0 0测定 :胫骨后移由术前平均 11 0mm改善至术后 5 5mm。应力X线片测量示胫骨后移由术前平均 11 5mm改善至术后 5 2mm。失效 1例。结论 后交叉韧带双束重建手术是一种有效、可行的重建方法 ,早期临床效果满意。股四头肌腱是后交叉韧带重建的理想移植物。应充分重视复合韧带损伤 ,特别是后外复合体损伤。

Objectives To describe an alternative procedure of arthroscopic posterior cruciate ligament reconstruction using quadriceps tendon-patellar bone autograft and evaluate the early stage follow-up results. Methods Twenty consecutive cases of isolated and combined posterior cruciate ligament deficiency were studied. Quadriceps tendon with patellar bone block was used for preparation of Y-shaped autograft. Double femoral tunnels and single tibial tunnel were precisely drilled respectively at their anatomical footprint. By using this technique,the anterolateral bundle was fixed and tensioned in 90° flexion, whereas the postero-medial bundle was fixed in full extension.In cases of combined injury,reconstruction or primary repair was conducted in one-stage or two-stage procedure. Results All cases were followed up for 6 months to 12 months, averaging 7.5 months. Lysholm rating scales and IKDC evaluation were used to make clinical subjective evaluations.Anteroposterior translation was measured with KT-1000 arthrometer and stress view radiography. Finial Lysholm evaluation showed 5 patients (25%)were excellent, 14(70%) good, and 1(5%) poor. IKDC evaluation showed that 1 patient(5%) was graded as A, 16(80%) as B, 2(10%) as C and 1(5%) as D. Stress view examination and KT-1000 arthrometer measurement showed that the average posterior translation improved from 11.5 mm and 11.0 mm preoperatively to 5.2 mm and 5.5 mm postoperatively.One patient was graded as failure. Conclusions Arthrosopy assisted prodedure of double-bundle posterior cruciate ligament reconstruction is effective and reproducible. The short follow-up clinical results are encouraging.Quadriceps tendon is an ideal autograft alternative for posterior cruciate ligament reconstruction.Combined posterior cruciate ligament injury,especially posterolateral complex insufficiency,should be early recongnized and treated properly.