关节镜下双束腘绳肌腱股骨双隧道和微型钢板纽扣重建后交叉韧带  

Simultaneous arthroscopic reconstruction of posterior cruciate ligament with hamstring tendons of double-tunnel and mini-plates and buttons

作　　者：谭海涛[1] 林源[1] 陆俭军[1] 蒙诗景[1] 江建中[1] 杨克勤[1] 韦平欧[1] 

机构地区：[1]广西医科大学第八附属医院,贵港市人民医院骨科,贵港市人民医院骨科537100

出　　处：《中华创伤杂志》2005年第5期345-348,共4页Chinese Journal of Trauma

基　　金：广西壮族自治区青年基金资助项目(桂科青0339034)

摘　　要：目的探讨应用双束腘绳肌腱股骨双隧道和微型钢板纽扣固定法重建后交叉韧带(PCL)的临床效果。方法对13例单纯PCL断裂的患者在关节镜下用腘绳肌双束股骨双隧道和微型钢板纽扣固定法进行重建。其中男9例,女4例;年龄20-53岁,平均36岁;新鲜损伤9例,陈旧性损伤4例。全部取自体半腱肌腱和股薄肌腱作为移植物。根据PCL的解剖特点,将肌腱编织成"Y"形的两束。PCL两束股骨附着点分别钻孔,成双隧道。用微型钢板和纽扣分别固定股骨和胫骨端。结果术后3个月,所有患者均无伸膝受限,膝关节屈膝活动度均>120°。术后1年,屈膝70°时后抽屉试验Ⅰ度阳性1例,其余均为阴性;屈膝30°时后抽屉试验Ⅰ度阳性2例,其余均为阴性;膝关节功能Lysholm评分为(92.51±2.40)分。结论在关节镜下利用腘绳肌腱股骨双隧道和微型钢板纽扣法重建PCL能够更可靠地恢复膝关节功能。Objective To study the clinical outcome of arthroscopic reconstruction of postericor cruciate ligament ( PCL) with hamstring tendons of double-bundle and mini-plates and buttons. Methods Hamstring tendons of double-bundle and mini-plates and buttons were performed to arthroscopically reconstruct 13 cases of PCL ruptures, in which there were nine males and four females, with age range from 20 to 53 years ( mean 36 years). There were nine cases with fresh injuries and four with old ones. In all cases, autosemitendinosus and gracilis tendon were harvested for transplants. Based on anatomical character of PCL, the tendons were woven to two bundles shaped 'Y'. Then, the femoral tunnels were drilled anterior to the insertion of PCL on femur to form double tunnel. Mini-plates and buttons were used to fixate the femur and the tibia. Results No extension limitation occurred and the flexion degree was more than 120° in all cases three months after operation. One year after operation, posterior drawer test at 70° flexion was negative in all but one cases who had one-degree instability; posterior drawer test at 30°flexion were one degree positive in two cases, and negative in other cases; the Lysholm knee score were 92. 51±2. 40. Conclusion Arthroscopic reconstruction of PCL with hamstring tendons and mini-plate and button is reliable for the restoration of knee function.

关 键 词：微型钢板纽扣 后交叉韧带 腘绳肌腱 关节镜下 股骨 隧道 重建 后抽屉试验 膝关节功能 自体半腱肌腱 陈旧性损伤 PCL 临床效果 股薄肌腱 解剖特点 固定法 移植物 活动度 屈膝 患者 术后 阳性 Ⅰ度 阴性 

分 类 号：R687[医药卫生—骨科学]