关节镜下股骨单隧道与双隧道重建后十字韧带的疗效分析

Evaluation of the clinical effects for the reconstruction of the posterior cruciate ligament with uni- and double-bundle under arthroscopy

目的分析比较关节镜下单束单隧道与双束股骨双隧道重建后十字韧带(PCL)术后的临床效果。方法1999年1月～2001年12月,采用单束前外束重建法重建PCL 18例,男14例,女4例;年龄18～50岁,平均35.5岁;右膝12例,左膝6例。移植物为骨-髌腱(中1/3)-骨的11例,半腱肌腱和股薄肌腱的7例。于PCL股骨附着点解剖中心的稍前方钻取股骨隧道,屈膝70°,拉紧并固定移植物。2000年1月～2002年12月,采用双束股骨双隧道法重建PCL12例,男10例,女2例;年龄21～47岁,平均33岁;右膝9例,左膝3例。移植物为半腱肌腱和股薄肌腱的7例,一端带髌骨块的股四头肌肌腱的5例。将肌腱编织分为两束。于股骨侧钻取双隧道。两束分别于屈膝70°和0°时拉紧并固定。结果采用前外束重建法的18例患者平均随访23个月,采用双束股骨双隧道重建法的12例患者平均随访17个月。前外束重建组与双束股骨双隧道重建组随访时的Lysholm评分分别为(92.4±3.7)分和(94.3±3.4)分,两组间差异无显著性(P>0.05)。屈膝0°和30°时,前外束重建组的胫骨后移距离是(5.9±0.4)mm和(6.2±0.5)mm,双束股骨双隧道重建组是(3.5±0.3)mm和(4.0±0.4)mm,两组间差异有显著性(P<0.05);屈膝60°和90°时,两组胫骨后移距离差异无显著性(P>0.05)。

Objective To compare the clinical effects of the reconstruction with uni- and double-bundle for the posterior cruciate ligament (PCL) under arthroscopy. Methods From 1999 to 2001, 18 patients had undergone arthroscopic uni-bundle PCL reconstruction, including 14 males and 4 females with an average age of 35.5 years (range, 18 to 50 years). Bone-patellar tendon-bone graft was used in 11 and hamstring tendon in 7. The femoral tunnels were drilled anterior to the insertion of PCL on femur. The grafts were tightened and fixed in 70° flexion. From 2000 to 2002, 12 cases had undergone double-bundle PCL reconstruction, including 10 males and 2 females with an average age of 33 years(range, 21 to 47 years). Quadriceps tendon with patellar bone block was used as the graft in 5, and hamstring and gracilis tendon in 7. The graft tendon was divided into two bundles. Two femoral tunnels were precisely drilled respectively anterolateral and posterointernal to the insertion of PCL on femur. The two bundles were tightened and fixed in 70° flexion and full extension respectively. Results 18 cases undergone uni-bundle PCL reconstruction were followed up from 10 to 33 months(mean, 23 months), while the 12 cases undergone double-bundle PCL reconstruction were followed up from 7 to 22 months (mean, 17 months). According to Lysholm rating scales, the scores of uni- and double-bundle for PCL reconstruction were respectively 92.4±3.7 and 94.3±3.4. It was of no statistical significance(P>0.05). Measured by KT-1000 arthrometer, the posterior tibial translations in the group of the uni-bundle at 0° and 30° flexion were (5.9±0.4) mm and (6.2±0.5) mm; but the posterior tibial translations in the group of the double-bundle at 0° and 30° flexion were (3.5±0.3) mm and (4.0±0.4) mm. It was of statistical significance (P<0.05). At 60° and 90° flexion, it was of no statistical significance in the two groups (P>0.05). Conclusion The clinical results of double-bundle PCL reconstruction is superior to that of the uni-bundle. Arthroscopic double-bundle PCL reconstruction is able to restrict the posterior tibial translation and restore the stability of the knee joint within its full range of flexion.