关节镜下自体四股腘绳肌腱重建膝前交叉韧带  

Anterior cruciate ligament reconstruction with autogenous quadrupled hamstring tendons under arthroscopic guide

作　　者：孙磊[1] 宁廷民[1] 田敏[1] 胡宏伟[1] 李叶红[1] 张红[1] 

机构地区：[1]解放军第八十八医院全军骨科中心,泰安271000

出　　处：《中华创伤杂志》2005年第5期336-340,共5页Chinese Journal of Trauma

摘　　要：目的评估关节镜下自体四股腘绳肌腱重建膝前交叉韧带(ACL)的技术和效果方法1999年10月-2003年12月共56例患者经关节镜检查证实为ACL断裂,26例伴半月板破裂,7例伴内侧副韧带损伤,12例伴后交叉韧带断裂。均于关节镜下行自体四股腘绳肌腱ACL重建术,采用Bionx生物可吸收挤压螺钉或钛挤压螺钉解剖位固定重建韧带。结果本组术后早期均未发生严重并发症。术后随访6-48个月,平均20个月,Lysholm膝关节功能评分由术前45-80分(平均58.36分),提高至随访时70-100分(平均92.77分)(P<0.01)。国际膝关节文件编制委员会(IKDC)综合评定由术前异常(C级)14例、显著异常(D级)42例,改进为随访时正常(A级)23例、接近正常(B级)29例、异常(C级)4例(P<0.01)。56例患者中,52例恢复伤前运动水平,4例运动水平较伤前降低。结论关节镜下自体四股腘绳肌腱重建膝ACL具有手术损伤较小、术后膝关节功能恢复良好的优点,值得采用。Objective To evaluate the technique and outcome of quadrupled hamstring tendons in arthroscopic anterior cruciate ligament ( ACL) reconstruction. Methods From October 1999 to December 2003, 56 cases with ACL tear were verified by arthroscopy. Of all, 26 cases were combined with meniscus injury, six with medial collateral ligament sprain and 12 with posterior cruciate ligament tear. All the damaged ACLs were reconstructed with autogenous quadrupled hamstring tendons under arthroscopy and Bionx bioabsorbable interference screw or blunt titanium interference screw used for direct anatomic fixation of the reconstructed ligament. Results No severe complications occurred at early stage after operation in 56 cases that were followed up for 6-48 months, average 20 months. Lysholm score was remarkably improved from 45-80 ( mean 58. 36) preoperatively to 70-100 ( mean 92. 77) at follow up ( P < 0.01). Furthermore, based on International Knee Documentation Committee (IKDC) score, there were 14 abnormal knees (grade C) and 42 severely abnormal knee (grade D) preoperatively; but after operation , there were 23 normal knees ( grade A) , 29 nearly normal knees (grade B) and four abnormal knees ( grade C) at follow up, with a statistically significant improvement ( P <0. 01 ). Of 56 cases, 52 restored to normal level but four not. Conclusion Arthroscopic ACL reconstruction with quadrupled hamstring tendons has advantages of minimal trauma in surgery and reliable satisfactory outcome, especially for cases with extensor mechanism problems.

关 键 词：四股腘绳肌腱重建 膝前交叉韧带 关节镜下 自体 内侧副韧带损伤 后交叉韧带断裂 膝关节功能恢复 挤压螺钉 关节镜检查 2003年 1999年 半月板破裂 生物可吸收 严重并发症 ACL 术后早期 术后随访 功能评分 综合评定 文件编制 

分 类 号：R687[医药卫生—骨科学] R686.5[医药卫生—外科学]