关节镜下股四头肌腱-骨双束股骨双隧道重建膝后十字韧带  

The technique of double-tunnel with double-bundle for reconstruction of the posterior cruciate ligament with quadriceps tendon-patellar bone under arthroscopy

作　　者：孙康[1] 汤继文[2] 王立德[3] 徐强[1] 刘晓阳[1] 齐晓君[1] 孙玉杰[1] 张羽飞[3] 

机构地区：[1]青岛大学医学院附属烟台毓璜顶医院骨科,264000 [2]山东大学齐鲁医院骨科 [3]大连医科大学附属第一医院骨科

出　　处：《中华骨科杂志》2004年第8期491-494,共4页Chinese Journal of Orthopaedics

摘　　要：目的探讨股四头肌腱-骨(QT-B)双束股骨双隧道重建膝后十字韧带(PCL)的方法与疗效.方法共32例PCL损伤患者,男28例,女4例;年龄19～47岁,平均29.8岁.急性损伤14例,慢性损伤l8例.取自体同侧QT-B,制备成'Y'形双束移植物,通过关节镜行前外与后内束股骨双隧道PCL重建,分别在屈膝90°和30°位拉紧、固定PCL前外与后内束.结果 32例均获得13～27个月(平均153个月)的随访.后抽屉试验后方不稳定较术前平均恢复1.1度.国际膝关节评分委员会(IKDC)评分A级9例(28%),B级19例(59%),C级3例(9%),D级1例(3%).Lysholm-Tegner膝关节功能综合评定分别由术前的(61±5)分和(3.9±1.8)分升至(90±8)分和(7.8±1.7)分.屈膝25°和90°KT-2000测定:胫骨后移由术前平均(12.9±2.9)mm和(13.8±3.6)mm,减少为术后(4.9±2.0)mm和(5.7±2.6)mm;健患侧胫骨后移差异由术前平均(7.9±1.4)mm和(8.5±1.8)mm,改善至术后(2.9±0.8)mm和(3.3±1.0)mm.结论PCL双束双隧道重建可更好地恢复膝关节在不同屈伸角度的稳定性,QT-B是双隧道重建的理想移植物.Objective To explore the technique and outcome of the procedure of double-tunnel with double-bundle for reconstruction of posterior cruciate ligament (PCL) using quadriceps tendon-patellar bone under arthroscopy. Methods 32 patients (28 males, 4 females) were involved of the lesion of PCL. Their average age was 29.8 years, with a range of 19 to 47 years. The lesion included 14 acute injuries and 18 old injuries. The 'Y' shaped double-bundle autograft was made from the ipsilateral side, then the anterolateral and posteromedial bundles of PCL were reconstructed through the double-tunnel in the femur arthroscopically, the two bundles were tightened and fixed with the knee flexion at 90° and 30°. Results All the patients were available at follow-up, with a mean of 15.3 months (range, 13-27 months). The posterior drawer test (PDT) posterior instability of the knee improved to 1.10 after operation. Based on the International Knee Documentation Committee(IKDC) evaluation, 9 patients(28%)were classified as grade A, 19(59%)as grade B, 3(9%) as grade C, and 1(3%) as grade D postoperatively. According to the Lysholm-Tegner rating systems, the average scores were 61 and 3.9 preoperatively, and they improved to 90 and 7.8 after operation respectively. The KT-2000 measurement showed that the average tibial posterior translation improved from (12.9±2.9) mm and (13.8±3.6) mm on knee flexion at 25° and 90° to (4.9±2.0) mm and (5.7±2.6) mm respectively after operation, and the difference of the average tibial posterior translation of bilateral side improved also from (7.9±1.4) mm and (8.5±1.8) mm before operation to (2.9±0.8) mm and(3.3±1.0) mm at the same flexion postoperatively(P>0.05). Conclusion The procedure of double-tunnel with double-bundle for reconstruction of posterior cruciate ligament (PCL) under arthroscopy can better improve the knee stability at the different flexion degree, and the QT-B is an optimal graft for the double-tunnel reconstruction.

关 键 词：股骨 术前 后十字韧带 股四头肌腱 重建 移植物 关节镜下 KT 综合评定 试验 

分 类 号：R687[医药卫生—骨科学]