关节镜下保留前交叉韧带残端解剖重建早期疗效观察  

Early curative effect of anatomical reconstruction by retaining anterior cruciate ligament residual end under arthroscopy

作　　者：王辉[1] 沈建平[1] 邹宏[1] 殷勇[1] 谢成[1] 杨帆[1] 冯国滨[1] 弋石泉[1] 

机构地区：[1]四川省绵阳市骨科医院关节外科,绵阳621000

出　　处：《骨科》2012年第4期187-190,共4页ORTHOPAEDICS

摘　　要：目的探讨关节镜下保留前交叉韧带(ACL)残端解剖重建的疗效。方法 2010年8月～2012年2月共收治43例前交叉韧带损伤患者。采用4～5股股薄、半腱肌腱单束重建ACL;股骨端采用Endo-button悬吊固定,胫骨端采用拴桩加挤压螺钉固定。结果术后43例患者全部获得随访,随访时间6～24个月。术后平均10周活动度恢复至90°;术后4个月活动度恢复大于120°,伸直0°。Lysholm膝关节功能评分从术前23.6分改善至91.3分。40例患者复查Lachman试验(-),中立位及内外旋位ADT(-),轴移试验(-);3例患者复查ADT(+),前移小于5mm。复查X线片显示骨隧道愈合满意。结论关节镜下保留前交叉韧带残端解剖重建更有利于膝关节旋转稳定性恢复;有效保留韧带残端重建,有利于促进重建韧带的再血管化。保留残端影响定位点的观察,对技术要求较高;否则得不偿失。早期随访关节稳定性恢复良好,远期效果有待进一步观察。Objective To explore the curative effect of anatomical reconstruction by retaining the anterior cruciate ligament（ACL） residual end under the arthroscopy.Methods From Aug.2010 to Feb.2012,43 patients with ACL damage were treated,including 29 males and 14 females who were aged from 21 to 60 years old（mean 36.7）.ACL was reconstructed with 4-5 femoral graciles and the half tendon single beam.The femoral head was subject to the Endo-button suspension fixation.The tibial end was fastened by using the tied pile and extruded screw.Results All 43 patients were followed up for 6 to 24 months.The average range of motion recovered to 90 degrees during 10 weeks after surgery,with more than 120 degrees,and 0 degree extension at 4th postoperative month.Lysholm knee function scores were increased from 23.6 to 91.3 points.Forty patients were reexamined with Lachman test（-）,neutral and internal and external rotation ADT（-）,the pivot shift test（-）;3 patients were reexamined by ADT（＋）,with the advancement of less than 5 mm.The X-ray showed satisfaction of the bone tunnel healing satisfaction.Conclusion The anatomic reconstruction by retaining the ACL stump under the Arthroscopy is more advantageous to the knee recovery of the rotation stability.Meanwhile,It is not only effective to retain the ligament stump reconstruction,but also conducive to the promotion of the reconstructed ligament revascularization.The retention of stump and the observation of the positioning points acquire a higher technique.Otherwise the loss outweighs the gain.The joint stability of early follow-up is favorable,and the long-term results need a further observation.

关 键 词：关节镜 前交叉韧带 骨重建 

分 类 号：R687.4[医药卫生—骨科学]