关节镜下保留残迹的后交叉韧带重建  

Arthroscopic posterior cruciate ligament （PCL） reconstruction with retention of PCL remnant

作　　者：孙磊[1] 田敏[1] 宁廷民[1] 张红[1] 宁志杰[1] 马清元[1] 

机构地区：[1]解放军第八十八医院全军骨科中心,泰安271000

出　　处：《中华创伤杂志》2008年第8期639-643,共5页Chinese Journal of Trauma

摘　　要：目的评估关节镜下保留残迹的膝后交叉韧带（PCL）单束重建的技术和效果。方法自2004年4月至2006年6月，38例（38膝）患者经临床和关节镜检查证实为PCL功能不全，其中9膝伴后外侧角损伤，6膝伴后内侧角损伤，8膝伴外侧半月板破裂，4膝伴内侧半月板损伤。均于关节镜下行保留残迹和滑膜的PCL单束重建术，采用生物可吸收挤压螺钉解剖位复合固定重建韧带。结果本组术后早期均未发生严重并发症。术后随访12～37个月[（20．79±7．92）个月]，Lysholm膝关节功能评分由术前40～70分[（51．32±9．84）分]，提高至随访时70～100分[（92．37±6．95）分]（t=-30．14，P〈0．01）：国际膝关节文件编制委员会（IKDC）标准由术前异常（C级）16例、屁著异常（D级）22例，改进为随访时正常（A级）18例、接近正常（B级）18例、异常（C级）2例（Z=-6．00，P〈0．01）。38例患者中，36例恢复伤前运动水平，2例运动水平较伤前减低。结论关节镜下保留残迹的PCL单束重建技术可行，治疗效果满意。保留PCL残迹与滑膜可能有利于重建韧带植入物生物愈合和神经再支配。Objective To evaluate the skill and outcome of arthroseopic reconstruction of posterior crueiate ligament （PCL） with retention of PCL remnant, Methods From April 2004 to June 2006, 38 patients （38 knees） with PCL deficiency were verified by clinical and arthroseopie examinations. Of them, there were 9 knees combined with disruption of the posterolateral corner, 6 with rupture of the posteromedial corner, 8 with lateral meniscus tear and 4 with medial meniscus tear. With reservation of PCL remnant and synovium, all the impaired PCLs were reconstructed with single bundle of autogenous quadrupled hamstring tendons under arthroseopy. Interference screws were used for direct anatomic fixation of the reconstructed ligament, Results No severe complications occurred at early stage after operation in all 38 patients who were followed up for 12-37 months （average 20.79 months）. Lysholm score was improved significantly from 40-70 points （ mean 51.32 points） before operation to 70-100 points （mean 92.37 points） at the latest follow up （t = -30.14, P 〈 0.01 ）. According to International Knee Documentation Committee （IKDC） score, there was a remarkable improvement from 16 abnormal knees （grade C） and 22 severely abnormal knees （grade D） preoperatively to 18 normal knees （ grade A）, 18 nearly normal knees （ grade B） and 2 abnormal knees at the latest follow up （Z = -6, 00, P 〈0.01 ）, Of 38 patients, 36 returned to normal sports level but 2 degraded level of sports. Conclusions Arthroseopic PCL reconstruction with retention of PCL remnants is a feasible technique, with satisfactory outcome. Preservation of PCL remnants and synovium may be beneficial to biological incorporation and reinnervation of the reconstructed ligament.

关 键 词：膝关节 后交叉韧带 关节镜 

分 类 号：R686[医药卫生—骨科学]