关节镜下保留残端五重折股薄肌腱重建前交叉韧带的疗效分析  

Arthroscopic reconstruction of anterior cruciate ligament with the tibial remnant tendon and gracilis tendon autograft

作　　者：季卫锋[1] 童培建[1] 马镇川[1] 卢荟[2] 厉驹[1] 

机构地区：[1]浙江省中医院骨伤科,杭州310006 [2]浙江大学附属第一医院骨一科

出　　处：《中华创伤骨科杂志》2009年第10期906-910,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的 介绍一种单独应用股薄肌腱重建前交叉韧带（ACL）的方法，并评估其疗效。方法2003年4月至2008年5月，前瞻性研究采用保留ACL胫骨侧残留部分单独应用股薄肌腱重建ACL的方法治疗40例ACL损伤患者，其中男22例，女18例；年龄17～43岁，平均30．7岁。急性损伤33例，陈旧性损伤7例。受伤至手术时间平均3．4周（1～12周）。术中评价所取股薄肌腱的长度，移植腱的长度及直径。术后评价包括KT-2000的前方不稳定性患健差，膝关节活动度，屈膝肌力的患健差，手术前后的IKDC评分及VAS评分。结果所取股薄肌腱的长度平均为239mm；移植腱直径为7．6mm，长度为41．4mm。KT-2000的前方不稳定性患健差术前平均为5mm，术后平均为1mm，差异有统计学意义（P〈0．05）。膝关节活动度与健侧最大相差不到5°，差异无统计学意义（P〉0．05）。术后6个月患膝在60°／s伸膝时扭矩恢复到健侧的89％，术后1年恢复到92％，术后2年恢复到95％；术后6个月患膝在90°／s屈膝时扭矩恢复到缝侧的85％，术后1年恢复到86％，术后2年恢复到89％。术前IKDC评分平均为49．3分，术后2年平均为95．0分；VAS评分术前平均为30．3分，术后2年平均为85．4分，差异均有统计学意义（P〈0．05）。结论单独应用股薄肌腱重建ACL，屈膝肌力恢复满意。保留残留韧带可促进重建韧带的血运和本体感觉的恢复，加速患者的康复。Objective To introduce an operative method for anterior cruciate ligament （ACL） reconstruction by using the graeilis tendon autograft and the tibial remnant tendon. Methods From April 2003 to May 2008, 40 patients, 22 males and 18 females, underwent ACL reconstruction only with gracilis tendon autograft while the remnants of tibial ACL tendon were preserved. They had an average age of 30.7 （17 to 43） years. There were 33 cases of acute injury and 7 cases of old injury. Intervals from injury to operation averaged 3.4 （1 to 12） weeks. We determined the mean length of graeilis tendon and the mean diameter and length of graft tendon. We compared the pre- and postoperative values of the anteroposterior laxity with the KT-2000 arthrometer, the bilateral postoperative ranges of motion, and the bilateral knee flexor torques 6, 12 and 24 months after surgery with BIODEX, as well as the IKDC scores before and after surgery. Results The mean length of harvested gracilis tendon was 239 ram, and the mean diameter and length of the graft tendon folded into 5 strands were 7.6 mm and 41.4 mm respectively. There was no postoperative difference in range of motion between the suffered and healthy knees. The preoperative values of anteroposterior laxity evaluated with the KT-2000 arthrolneter averaged 5.0 mm, and the postoperative values averaged 1.0 mm. The average postoperative knee flexor torques of 60°/s was 89% at 6 months, 92% at 12 months and 95% at 2 years. The average postoperative knee flexor torques of 90°/s was 85% at 6 months, 86% at 12 months and 89% at 2 years. The average IKDC score was 49.3 points preoperatively and 95.0 minutes 2 years postoperatively. There was a significant difference between the average preoperative VAS score （30.3） and the postoperative one （85.4） （P 〈 0. 05） . Conclusions The ACL reconstruction can be done with graeilis tendon autograft and the tibial remnant tendon. The ACL remnants can be preserved as a source of reinnervation and regeneration of blood circulation

关 键 词：前交叉韧带 肌 骨骼 腱 关节镜检查 

分 类 号：R686[医药卫生—骨科学]