关节镜下四股腘绳肌腱单束重建膝关节后交叉韧带  

Single bundle reconstruction of posterior cruciate ligament with autogenous quadrupled hamstring tendons

作　　者：孙磊[1] 宁志杰[1] 田敏[1] 胡宏伟[1] 宁廷民[1] 张红[1] 马清元[1] 高加智[1] 

机构地区：[1]解放军第88医院全军骨科中心,山东泰安271000

出　　处：《中国矫形外科杂志》2005年第24期1854-1857,共4页Orthopedic Journal of China

摘　　要：[目的]评估关节镜下四股腘绳肌腱单束重建膝后交叉韧带(PCL)的技术和效果.[方法]自2001年4月～2004年10月,49例病人(49膝)经关节镜检查证实为PCL断裂,其中13膝伴前交叉韧带断裂,14膝伴后外侧角损伤,6膝伴后内侧角损伤,9膝伴外侧半月板破裂,5膝伴内侧半月板损伤,2例伴腘动脉损伤,4例伴腓总神经损伤.均于关节镜下行自体四股腘绳肌腱单束PCL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10～52个月,平均22个月,Lysholm膝关节功能评分由术前30～60分(平均47.96分),提高至随访时70～95分(平均89.08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)10例、显著异常(D级)39例,改进为随访时正常(A级)20例、接近正常(B级)24例、异常(C级)5例(P=0.0000).49例患者中,40例恢复伤前运动水平,9例运动水平较伤前减低.[结论]关节镜下自体四股腘绳肌腱单束重建膝PCL创伤小、手术操作简捷,术后膝关节功能恢复满意.[ Objective ] To evaluate the technique and outcome of arthroscopic single bundle reconstruction of posterior cruciate ligament （PCL） with quadrupled hamstring tendons. [ Method] From April 2001 to Oct 2004, 49 knees with PCL tear in 49 patients were verified with arthroscopy in this department. Of them, 13 knee were combined with anterior cruciate ligament tear , 14 combined with disruption of the posterolateral coruer, 6 combined with rupture of the posteromedial coner and medial collateral ligament, 9 combined with lateral meniscus tear and 5 combined with medial meniscus tear. All the damaged PCLs were reconstructed with single bundle of autogenous quadrupled hamstring tendons under arthroscopy. Bionx bioabsorbable interference screw or blunt titanium interference screw was used for direct anatomic fixation of the reconstructed ligament. [ Result ] No severe complication occurred in early stage after operation in the 49 patients. All of them were followed up for 10 to 52 months with an average of 22 months. Lysholm score was remarkabldy improved from 30 ～ 60 （ mean 47.83 ） preoperatively to 70 ～ 95 （ mean 89.35 ） at follow up（ P 〈 0. 0001 ）. Furthermore, there was a significant improvement in IKDC score from abnormal （ grade C） in 10 knees and severely abnormal （ grade D ） in 39 knee preoperatively to normal （ grade A） in 20 knees, nearly normal （ grade B ） in 24 knees and abnormal in 5 knees at follow up （P = 0. 0000）. Of the 49 patients, 40 patients returned to the same preinjury sports level and 9 were under the level. [ Conclusion] Single bundle reconstruction of PCL with quadrupled hamstring tendons has advantages of minimal trauma in surgery and reliablely satisfactory outcome.

关 键 词：膝关节 后交叉韧带 关节镜 四股腘绳肌腱 单束重建 挤压螺丝钉 

分 类 号：R687.3[医药卫生—骨科学]