保留交叉韧带前内侧束或后外侧束与残端重建ACL的价值  

Value of reconstruct anterior cruciate ligament for remaining anteromedial or posterolateral bundle and ruptured fiber

作　　者：刘玉杰[1] 李志超[1] 李海鹏[1] 薛静[1] 王志刚[1] 李众利[1] 蔡胥[1] 李光辉[1] 魏民[1] 朱娟丽[1] 

机构地区：[1]解放军总医院骨科医院,北京复兴路28号100853

出　　处：《中国矫形外科杂志》2008年第2期89-91,共3页Orthopedic Journal of China

摘　　要：[目的]探讨保留交叉韧带（anterior cruciate ligament，ACL）部分束支与残端纤维对前交叉韧带（ACL）重建的价值。[方法]前交叉韧带损伤89例，其中运动伤32例，训练伤24例，交通事故伤23例，生活中扭伤10例。关节镜下发现ACL在股骨髁间窝处断裂24例，胫骨髁间止点断裂28例，ACL前内侧束（AMB）断裂14例，后外侧束（PLB）断裂23例。采用保留ACL残端四股胭绳肌腱结嵌压固定法重建32例，自体带髌骨块的股四头肌腱嵌压固定法重建20例；保留ACL前内侧束和后外侧束双股胭绳肌腱结嵌压固定重建37例。胫骨端采用界面钉固定和在胫骨桥上肌腱缝线打结固定。[结果]术后均得到随访，时间14～37个月，平均25个月，术后膝关节稳定性增强，Lysholm膝关节功能评分，术前平均67．5分，终末随访平均95．2分，术后提高27．7分。Rulermetr测试胫骨位移距离4mm±3mm72例，6mm±2mm17例；Lachman试验阴性79例，弱阳性8例，阳性2例。按膝关节疗效评定标准，优76例，良13例。[结论]保留交叉韧带前内侧束或后外侧束与残端重建ACL，有助于移植肌腱再血管化及爬行替代和本体感觉建立，有利于维持膝关节稳定性。[ Objective] To evaluate the curative effect of anterior cruciate ligament （ACL）reconstruction for remaining anteromedial or posterolateral bundle and ruptured fiber. [ Method ] Among 89 cases of ACL rupture, there were 32 cases of sports injury ,24 cases training injury,23 cases traffic accidents and 10 cases sprained in daily life. ACL ruptured at the notch of the femur in 24 cases, and at the intercondyle of the tibial in 28 cases. Thirty-two cases were reconstructed with quadri-bundle Hamstring tendon knot press-fit technique and 20 cases were reconstructed with quadriceps tendon press-fit technique with autogenetic patellar bone. ACL anteromedial bundle（AMB） ruptured in 14 cases and posterolateral bundle （ PLB ） ruptured in 23 cases. The intact bundle and the remnants of ACL were preserved. AMB and PLB were reconstructed with double-bundle Hamstring tendon knot press-fit technique in 37 cases. Absorbable interference screws were used at the tibial tunnel and sutured tendon was knotted across the tibial bone bridge. [ Result ] The average duration of follow-up were 25 months （ 14 -37 months）. Lysholm knee func- tion score increased by 27.7 scores, from average 67.5 scores of pre-operation to average 95.2 scores at the end of the follow-up. Rulermetr examination tibial translation was 4 mm ± 2 mm in 72 cases and 6 mm ± 3 mm in 17 cases. Lachman test was negative in 79 case, weakly positive in 8 cases and positive in 2 cases. The function of the knees were improved and the stabilization was strengthened after operation. According to knee therapeutic effect evaluation criterion, 76 cases were excellent and 13 cases were good. [ Condnsion]To keep the remaining of anteromedial or posterolateral bundle and ruptured fiber for ACL reconstruction is beneficial for the graft revascularization or healing, and is helpful for the position sense or rehabilitation.

关 键 词：交叉韧带 关节镜 膝关节 肌腱移植 

分 类 号：R687[医药卫生—骨科学]