关节镜下骨栓腘绳肌腱结嵌入固定法重建膝前后十字韧带

Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction with an implant fixation of hamstrings tendons knot and bone bolt press-fit technique

目的探讨关节镜下以自体骨栓绳肌腱结嵌入固定法联合重建膝前、后十字韧带损伤的应用价值。方法2000年2月～2003年6月,采用自体骨栓绳肌腱结嵌入固定法同期联合重建前、后十字韧带损伤15例,男10例,女5例;年龄19～31岁,平均23岁;左9例,右6例。取自体绳肌腱,断端编织缝合并预张力后,在双股肌腱的中间打结嵌入骨栓并缝合固定。股骨隧道采用阶梯联合钻一次成形,呈倒置的瓶颈状。然后定位并建立前、后十字韧带的胫骨隧道。将“T”形的骨栓肌腱结嵌入瓶颈状股骨隧道内,两组肌腱缝线经胫骨隧道穿出,反复屈伸膝关节20次,在胫骨骨桥上交叉打结并缝合固定。术后患膝以支具固定在屈曲0°～30°位。结果15例患者均获得随访,随访时间5～26个月,平均9个月。膝关节功能评估采用Lysholm功能评分标准,术前平均(61.5±4.6)分,终末随访时平均(92.5±3.7)分,差异有显著性(P<0.05)。膝关节稳定,功能明显改善。结论骨栓绳肌腱结嵌入固定联合重建前、后十字韧带的方法为生物固定,避免使用高值耗材和分次手术,降低手术费用,利于术后功能康复。

Objective To evaluate the clinical outcomes of arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction, with an implant fixation of combined press-fit technique of hamstrings tendon knot and bone bolt. Methods 15 cases of combined injury of anterior and posterior cruciate ligament were reconstructed under arthroscopy. There were 10 males and 5 females, and the average age of patients was 23 years ranging from 19 to 31 years. 9 left knees and 6 right knees were involved. A hamstring was taken by standard procedure with a stripper, and pretension was performed on the harvested tendons; a bone bolt was inserted into the tendon to form a tendon knot. The bottle-neck shaped tunnel was prepared by stepping drill at the femoral side, the tendon knot and bone bolt was pulled inside of femoral tunnel, and then out of the tibial tunnel. Repeating the full extension and flexion of the knee joint for 20 times, and then the weaving suture of tendons was brought to pass underneath of tibial bridge and tightened together. Results The patients were evaluated by Lysholm knee functional scales, the average knee score were 61.5±4.6 and 92.5±3.7 respectively before and after operation, and the difference was of statistical significance(P<0.05). The patients were followed up for 5 to 26 months, there were no limitation of knee joint extension, the function and stability of walking and activities were improved apparently, there were no poor results. Conclusion Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction with an implant fixation of hamstrings tendon knot and bone bolt press-fit technique is a reliable method for the restoration of knee function, the advantages are biological fixation, avoidance of use of high cost material for fixation, benefit for healing of tendons within the bony tunnel, and low medical cost.