关节镜下多股半腱肌腱与股薄肌腱重建前十字韧带的临床应用  

Clinical research on the arthroscopic semitendinosus-gracilis tendon autograft for reconstruction of the anteri-or cruciate ligament

作　　者：夏春[1] 周江南[2] 胡海[1] 陈国能[1] 成有生[1] 

机构地区：[1]厦门大学医学院厦门中山医院骨科,现在361004 [2]中南大学湘雅医院骨科

出　　处：《中华骨科杂志》2003年第7期392-395,共4页Chinese Journal of Orthopaedics

摘　　要：目的探讨应用自体半腱肌腱与股薄肌腱重建前十字韧带(anteriorcruciateligament,ACL)的方法与疗效。方法对30例ACL损伤患者行关节镜下半腱肌腱与股薄肌腱ACL重建术。半腱肌腱与股薄肌腱均取自同侧,其中25例应用半腱肌腱与股薄肌腱进行重建;5例单纯应用半腱肌腱。将肌腱反复折叠为长约8.5cm的4～5股,在距两端2.5cm处分别用丝线编织捆绑缝合,用直径为7～8mm,长20～25mm的SoftSilk型挤压螺钉于屈膝20°～40°位固定,等长重建ACL。合并损伤于先期或同期治疗。结果术后随访7～30个月,平均15.9个月。所有患者术后4周膝关节均达正常活动范围。X线片显示24例内固定物位置良好,5例股骨侧和1例胫骨侧位置明显偏前。12例胫骨隧道和8例股骨隧道轻度扩大,无骨隧道明显扩大的病例。26例术后Lachman试验≤Ⅰ度,27例轴移试验阴性或Ⅰ度,Lysholm评分平均为87.5分,较术前平均54.5分显著增高,差异有显著性意义(P<0.05)。Tegner运动评级平均为5.2级,较术前平均2.8级有所增高。结论关节镜下挤压螺钉固定自体多股半腱肌腱与股薄肌腱重建ACL是治疗急、慢性ACL损伤的较好的方法。Objective In intra-articular the reconstruction of injured anterior cru ciate ligament,the bone-patellar tendon-bone was the most popular antogenous repaired mate rial but associated knee pain,re duction of muscle strength and so on.The present was to sum marize the surgical technique and clinical effect on the anterior cruciate ligament reconstruction using semitendinosus-gracilis tendon autograft.Meth ods A cohort of thirty pa-tients who had primary reconstruction of the anterior cruciate ligament with semi tendi nosus-gra cilis tendon auto-graft under arthroscopy,performed by one surgeon between June1999and August2001,were studied.There were19male and11female patients aging from17to57years with a mean of 30years.On examination,Lach-man there were degreeⅠin2cases,degreeⅡin11cases and degreeⅢin17cases.MRI suggested the injury of anterior cruciate ligament in28cases and suspicious in jury in2cases.Both semitendinosus tendon and gra cilis ten-dons were harvested in25cases,and single semi tendi nosus ten don was harvested in5cases.The harvested tendon was folded to four or five strands,which was about 8.5cm long on average,and their two ends were woven and threaded.All semitendi nosus-gra cilis ten don grafts were an chored by Soft Silk interference screws at the position of knee at20°to40°flexion,in cluding four biodegrad able screws in femoral sides.Results The average fol low-up was15.9months,ranging from7to30months.The range of motion was normal or nearly normal at all of the knees.The postoperative Lach man test was≤degreeⅠin26patients,degreeⅡin3cases and degreeⅢin1case.27cases showed an ab sent pivot shift.The average Lysholm score was postoperative87.5points com pared to preoperative54.5points,and the av erage Tegner activity grading scale increased from preoperative2.8to postoper-ative5.2points.Radiographs showed that inconspicuous bone tunnel enlargement occurred in12cases on the tibial side and8cases on the femoral side.Conclusion The arthroscopic anterior crucia

关 键 词：体半腱肌腱 股薄肌腱 前十字韧带损伤 Lysholm评分 修复术 

分 类 号：R687[医药卫生—骨科学]