应用同种异体韧带同时重建前、后十字韧带

Reconstruction of anterior and posterior cruciate ligaments with allograft tendon in one stage

目的 评价应用同种异体韧带同时重建前、后十字韧带损伤的临床疗效。方法 在我院确诊为膝前、后十字韧带损伤并应用同种异体韧带同时重建前、后十字韧带的患者 12例 ,术中应用同种异体髌韧带 8例、同种异体跟腱 4例 ,术中均采用缝线钮扣钢板悬吊式固定。其中 2例还行后外侧韧带结构重建 ,1例行后内侧韧带结构重建。术后随访 2 4～ 39个月 (平均 2 8个月 ) ,采用国际膝文件委员会韧带标准评价表 (IKDC)和Lysholm膝关节功能评分表评估患膝功能 ,通过KT 10 0 0检查膝关节前后松弛度。结果 术后高热 3例 ,约 2周恢复正常 ,无感染发生 ;术后均无伸膝受限 ,屈膝活动度为 10 0°～ 135° ,平均 12 6°。终末随访时IKDC评分为A者 4例(33.3% ) ,B者 7例 (5 8.3% ) ,C者 1例 (8.3% )。屈膝 2 5°位KT 10 0 0检查 ,双侧膝关节前向松弛度差异 <2mm7例 ,3～ 5mm 4例 ,7mm 1例 ;屈膝 70°位检查 ,双侧胫骨结节后坠差异 <2mm 9例 ,2～ 4mm 3例。患者术前Lysholm膝关节功能评分平均为 (6 5 .5± 3.2 )分 (4 8～ 72分 ) ,终末随访时为 (90 .2± 3.4 )分 (86～ 97分 ) ,差异有显著性 (P <0 .0 1)。结论 应用同种异体韧带同时重建前、后十字韧带 ,能较满意地恢复膝关节功能。

Objective To evaluate the therapeutic effect of reconstructed anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) with allograft tendon in one stage. Methods From December 1999 to December 2000, twelve cases of ruptured ACL and PCL were reconstructed with mini-plates and buttons fixed allograft ligaments in one stage. Eight cases were reconstructed with patellar allograft ligaments and the rest with Achilles allografts tendon. The posterolateral ligament complex in the two cases and posteromedial ligament complex in one case were also reconstructed. The patients were followed up for twenty-four to thirty-nine months. The IKDC and Lysholm knee score scale were used for functional evaluation. Results Three patients had high fever three days after operation and recovered to normal after two weeks. No infection occurred. There was no limitation of knee extension. Knee flexion was between 100° and 135° with an average of 126°. At termination of follow-up, IKDC score, was graded as A in four cases (33.3%), B in seven cases (58.3%), and C in one case (8.3%). KT-1000 examination at 25° flexion showed the difference in its degree of anterior laxation was less than 2 mm in seven cases, 3～5 mm in four cases, and 7 mm in one case. The difference in posterior sagging at 70° flexion was less than 2 mm in nine cases, 2～4 mm in three cases. The Lysholm score of the twelve cases was 65.5±3.2 before operation, and 90.2±3.4 at the last follow up. Statistically, the difference between the two Lysholm scores is significant (P<0.01). Conclusions Reconstruction of ACL and PCL with allograft tendon in one stage is satisfactory for restoration of knee function.