关节镜下应用同种异体髌腱联合重建前后交叉韧带的临床随访研究  

A follow-up study of arthroscopically assisted combined reconstruction of anterior and posterior cruciate ligaments with allogeneic patellar tendon

作　　者：谢峰[1] 杨柳[1] 郭林[1] 代灿[1] 韩雪松[1] 欧阳云飞[1] 王晓宇[1] 代伟[1] 

机构地区：[1]第三军医大学西南医院关节外科中心,重庆400038

出　　处：《第三军医大学学报》2007年第7期626-628,共3页Journal of Third Military Medical University

摘　　要：目的探讨关节镜下利用同种异体髌腱(骨-腱-骨组织,BPTB)联合重建前、后交叉韧带的近期临床效果。方法收集2003年5月至2005年11月间10例前、后交叉韧带联合损伤的患者,在关节镜下利用挤压界面螺钉固定,同种异体髌腱联合重建前交叉韧带和后交叉韧带。所有患者术后随访12～30个月(平均18个月)。按照国际膝关节评分委员会(international knee documental committee,IKDC)、Lysholm和Tegnar膝关节评分标准评价疗效。结果术后无伸膝受限,最后随访时屈膝活动度为120°～135°(平均128.38°)。Lysholm膝关节功能评分术前为48～78(66.5±5.6)分,终末随访时为85～96(89.8±3.4)分,手术前后有显著性差异(P<0.01)。Tegnar运动能力评价表在初次受伤前为4～9(6.9±1.7)分;伤后术前为0～3(2.2±0.6)分;随访结束时为2～9(5.5±1.6)分。受伤前和随访结束时评分无显著性差异。终末随访IKDC评分:A4例(40.0%),B5例(50.0%),C1例(10.0%)。10例患者中,8例恢复伤前运动水平,2例运动水平较伤前减低。结论关节镜下同种异体髌腱联合重建前交叉韧带和后交叉韧带手术操作精细、创伤小,术后膝关节功能恢复满意。Objective To evaluate the therapeutic effect on reconstruction of anterior cruciate ligament （ACL） and posterior cruciate ligament （PCL） simultaneously by using allogeneic patellar tendon under arthroscopy. Methods From May 2003 to November 2005, 10 cases of ruptured ACL and PCL were fixated with compressed screws and reconstructed under arthroscopy with allogeneic patellar tendon in one stage. The clinical results were evaluated according to IKDC, Lysholm, and Tegner clinical rating scales. Results All patients were followed up for 12 -30 months （average 18 months ）. At the end of follow-up, there was no knee extension limitation and the knee flexion was between 120 and 135, with an average of 128.38. The Lysholm score of the 10 cases was （66.5 ±5.6） before operation, and （89.8 ±3.4） at the end of follow-up. Statistically, the difference between the two Lysholm scores was significant （ P 〈 0.01 ）. The average Tegner activity score decreased in patients from （6.9 ± 1.7 ） （ range from 4 to 9 ） before injury to （5.5 ± 1.6 ） （ range from 2 to 9 ） at follow-up. At termination of follow-up, IKDC score was graded as A in four cases （40.0%） , B in five cases （50.0%）, and C in one case （ 10.0% ）. Of the 10 patients, 8 patients returned to the pretraumatic sports level and 2 were under the level. Conclusion Arthroscopically assisted combined reconstruction of ACL and PCL with allogeneic patellar tendon has the advantages of minimal trauma in surgery and reliable satisfactory outcome.

关 键 词：关节镜 前交叉韧带 后交叉韧带 移植 

分 类 号：R615[医药卫生—外科学] R686.5[医药卫生—临床医学]