改良定位胫骨隧道内口于“斜坡下”改善后交叉韧带重建术效果分析  

Effect analysis of improved location of tibial tunnel at “below slope” on reconstruction of posterior cruciate ligament

作　　者：王辉[1] 邹宏[1] 沈建平[1] 李剑峰[1] 张妍[1] 唐勇[1] WANG Hui;ZOU Hong;SHEN Jian-ping;LI Jian-feng;ZHANG Yan;TANG Yong(Department of Knee Joint,Mianyang Orthopaedic Hospital,Mianyang,Sichuan 621000,China)

机构地区：[1]绵阳市骨科医院膝关节科,四川621000

出　　处：《中国骨与关节损伤杂志》2018年第10期1026-1029,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的探讨关节镜下改良定位胫骨隧道内口于"斜坡下"改善后交叉韧带(PCL)重建术的效果。方法回顾性分析自2014-06—2016-06行关节镜下PCL重建术治疗的33例PCL损伤,采用穿后纵膈入路技术,定位器取60°～65°,定位胫骨隧道内口于"斜坡下",胫骨隧道内口位置位于胫骨平台后缘下2～3 cm,同时保证胫骨隧道与胫骨平台关节面夹角为40°～50°。结果 33例均获得随访,随访时间平均18(12～24)个月。术后5例后抽屉试验或台阶征阴性,25例为(+),2例为(++),1例为(+++)。末次随访时摄屈膝90°应力位X线片对比患肢与健侧胫骨平台后移距离,4例无明显差异,26例后移2～5 mm,2例后移5～10 mm,1例后移>10 mm;MRI显示重建后的PCL走行、张力接近正常PCL。5例术后2年取出内固定,二次关节镜检查可见重建的PCL愈合良好。末次随访时所有患者膝关节活动度恢复至0～120°,膝关节功能Lysholm评分平均92.3(91.3～94.7)分。结论关节镜下经胫骨隧道技术重建PCL时,改良定位胫骨隧道内口于"斜坡下"可有效避免"杀伤角效应",增加移植肌腱覆盖PCL足印面积,有效保留PCL残端以利于PCL愈合。Objective To study the effect of location of tibial tunnel at ＂below slope＂ on reconstruction of improved posterior eruciate ligament （PCL）. Methods Retrospective analysis of 33 cases of PCL injury treated by arthroscopie PCL reconstruction from June 2014 to June 2016 was conducted. The posterior mediastinal approach technology was used, the locator was 60°-65°, the internal tunnel of tibia was located under the ＂slope＂, which was 2-3 cm below the posterior edge of the tibial plateau. Meanwhile, the angle between the tibia1 tunnel and the articular surface of the tibial plateau was kept approximately 40°-50°. Results All 33 patients were followed up for an average of 18 （12-24） months. After surgery, 5 cases were negative for the post drawer test or step sign, 25 cases were positive （＋）, 2 cases were positive （＋＋）, and 1 case was positive （＋＋＋）. At the last follow-up, the tibia plateau posterior displacement distance was compared between two sides on the knee flexion 90° stress lateral radiographs, there was no significant difference in 4 cases, with 26 cases moving back 2-5 mm, 2 cases moving back 5-10 mm, and 1 case moving back over 10 mm. MRI showed that the morphology and tension of reconstructed PCL were close to those of normal PCL. At 2 years after surgery, internal fixation was removed in 5 patients, of whom the reconstructed PCL healed well in secondary arthroscopy. At the last follow-up, all patients＂ knee joints recovered to 0^-120~, the Lysholm score of knee function averaged 92.3 points （91.3-94.7）. Conclusion At the reconstruction of PCL by the tibia tunnel under arthroscopy, locating the tibial inner tunnel under the slope is able to effectively avoid the ＂killing angle＂ effect, then to increase the area of PCL footprints covered by the transplanted tendon, so as to preserve the stump of PCL effectively, which is beneficial to the healing of PCL.

关 键 词：后交叉韧带损伤 关节镜 胫骨隧道内口 胫骨平台斜坡下 韧带重建术 

分 类 号：R686.5[医药卫生—骨科学]