自体半腱和股薄肌腱移植双束重建膝关节后外侧角  

Two Bundle Anatomical Reconstruction of the Posterolateral Corner of the Knee Using Auto-Harmstring

作　　者：滕学仁[1] 胡光亮[1] 赵永生[1] 张其亮[1] 

机构地区：[1]青岛市市立医院骨科,青岛266071

出　　处：《中国运动医学杂志》2006年第6期647-650,共4页Chinese Journal of Sports Medicine

摘　　要：目的：观察采用自体半腱和股薄肌腱移植双束重建膝关节后外侧角韧带结构的近期临床效果。方法：对21例膝关节后外侧角韧带结构损伤患者（23个膝关节），采用自体半腱和股薄肌腱移植，双束重建膝关节后外侧角韧带结构。自体半腱肌腱移植物经胫骨骨道和腓骨骨道返折分别重建胭肌腱和胭腓韧带，于胭肌腱股骨外侧髁解剖止点处钻孔固定重建的胭肌腱和胭腓韧带；股薄肌腱移植物经腓骨骨道返折重建腓侧副韧带，于腓侧副韧带股骨外侧解剖止点处钻孔固定重建的腓侧副韧带。对于合并交叉韧带损伤者，同期行关节镜下韧带重建术。术后对患者膝关节内翻稳定性和外旋活动度进行至少1年（12～31个月，平均26、7个月）随访，通过Lysholm膝关节评分法评价膝关节术前、术后功能。结果：术后1年以上的回顾性随访中，膝关节完全伸直位无膝内翻不稳定者；屈膝30°位，无膝内翻不稳定者19例，膝内翻I度不稳定伴硬性终止点者2例；俯卧位膝关节屈膝30°，所有患者小腿外旋活动均与对侧相同；Lysholm膝关节评分术前平均54.3分，术后平均89.2分。结论：自体半腱和股薄肌腱移植双束重建膝关节后外侧角韧带结构具有移植腱割取创伤小、移植材料理想、解剖等长重建及固定强度高的特点，近期疗效理想。Objective To introduce the method of two bundle anatomical reconstruction of the posterolateral corner（PLC） of the knee using auto - harmstring, and to evaluate the short - term clinical outcomes. Methods Using auto - harmstring, 23 knees of 21 cases with acute or chronic posterolateral complex injuries were anatomically reconstructed from March 2003 to November 2005. There were 20 male and 1 female patients （mean age：32.3 years,ranging from 17 to 47 years）in this study with follow- up of at least 12 months（average：26.7 months, ranging from 12 to 31 months. Tow cases had isolated PLC injuries, 21 knees had multiligamentous injuries, and 5 cases associated with meniscus injuries. The technique used includes： （1）an autogenous semitendinosus placed through trastibial bone tunnel from posterior to anterior and then turned to transfibulur bone tunnel to reconstruct the popliteus and popliteofibular ligament; （2）an autogenous gracilis tendon placed through transfibulur bone tunnel to reconstruct the fibulocolateral ligament （FCL）. The transplanted grafts were secured to the femoral insertion of the popliteus and FCL respectively with metal or bioabsorbable interference screw. All patients were followed - up prospectively with clinical examinations and Lysholm knee scores. Results There was no varus knee instability in full extension, and one - grade varus instability with firm endpoint was found in 2 cases at 30° flexion. There was no increased external rotation in all of the 23 knees at 30° flexions （in prone position）. Mean Lysholm knee scores were 89.2 （range from 88 to 100）. Conclusions Two bundle anatomical reconstruction of the PLC of the knee using auto - harmstring yields a stable knee with excellent function,mini-trauma,and reliable fixation of grafts,this technique is an ideal method for the treatment of PLC injuries.

关 键 词：后外侧角 胭绳肌腱 重建 

分 类 号：R687[医药卫生—骨科学]