关节镜下采用腘绳肌肌腱和微型钢板纽扣同时重建前、后十字韧带

Simultaneous arthroscopic reconstruction of anterior cruciate ligament and poste rior cruciate ligament with hamstring tendons and mini-plates and buttons

目的关节镜下采用绳肌肌腱和微型钢板纽扣同时重建前、后十字韧带,并对重建效果进行评估。方法对12例前、后十字韧带损伤患者,在关节镜下采用同侧半腱肌肌腱和微型钢板纽扣重建前十字韧带,采用对侧半腱肌肌腱、股薄肌肌腱和微型钢板纽扣重建后十字韧带。其中2例还同时行后外侧韧带结构重建,1例同时行后内侧韧带结构重建。术后随访12～24个月,采用IKDC和Lysholm膝关节功能评分表对患膝功能进行评估,通过KT-1000检查了解膝关节的前后松弛度。结果术后无伸膝受限,屈膝活动度120°～140°,平均128°。终末随访时IKDC评分为A4例(33.3%),B7例(58.3%),C1例(8.3%)。屈膝25°位KT-1000检查,双侧膝关节前向松弛度差异小于2mm者8例,3～5mm者3例,7mm者1例;屈膝70°位检查,双侧胫骨结节后坠差异为0～2mm者9例,2～4mm者3例。陈旧性损伤患者术前Lysholm膝关节功能评分为(66.5±3.1)分,终末随访时为(93.8±3.5)分,差异具有非常显著性(t=5.376,P<0.01)。10例患者(83.3%)恢复了原来的运动水平,2例患者(16.7%)运动水平较前有所降低。结论在关节镜下采用双侧绳肌肌腱和微型钢板纽扣同时重建前、后十字韧带,能够较满意地恢复膝关节功能。

Objective To introduce the simultaneous arthroscopic reconstruc ti on techniques of anterior cruciate ligament (ACL) and posterior cruciate ligamen t (PCL) with hamstring tendons, fixed with mini-plates and buttons, and to evalu ate the results of simultanous ACL & PCL reconstruction. Methods Twelve cases of ACL and PCL ruptures were reconstructed arthroscopically with mini-plates and b uttons fixed hamstring tendons in one stage. Semitendinous tendons of the injure d leg were used for ACL reconstructions, while semitendinous and gracilis tendon s of the uninjured leg were used for PCL reconstructions. The posterolateral lig ament complex in two cases and posteromedial ligament complex in one case were a lso reconstructed. The patients were followed up for twelve to twenty-four month s. The IKDC and Lysholm knee score scale were used for function evaluation. The anterior and posterior knee laxity was examined by KT-1000. Results There was no knee extension limitation. Knee flexion was between 120° and 140°, with an av erage of 128°. According to the last IKDC evaluation, 4 cases (33.3%) were grad ed as A, 7 cases (58.3%) B, and 1 case (8.3%) C. KT-1000 examination at 25° fle xion showed that the side difference of anterior laxity was below 2 mm in 8 case s, was 3-5 mm in 3 cases, and 7 mm in 1 case. The side difference of posterior s ag at 70° flexion was 0-2 mm in 9 cases, 2-4 mm in 3 cases. The Lysholm score o f the nine chronic cases was 66.5±3.1 before surgery, and 93.8±3.5 at the last follow up. Statistically the difference between the two Lysholm scores has pro minent significance (t=5.376, P< 0.01). Conclusion Simultaneous arthroscopic rec onstruction of both ACL and PCL with mini-plates and buttons fixed hamstring ten dons and is reliable for knee function restoration.