关节镜下可调节带袢锁扣钢板全内重建后交叉韧带断裂的临床研究  

Clinical Research of Arthroscopic Posterior Cruciate Ligament All-inside Reconstruction with Adjusta-ble Tight-Rope Devices

作　　者：李金平[1] 李良军[1] 何志勇[1] 熊杰鹏 肖文峰[2] 丑克[1] LI Jin-ping;LI Liang-jun;HE Zhi-yong;XIONG Jie-peng;XIAO Wen-feng;CHOU Ke(Department of Orthopedics,Changsha Central Hospital(Affiliated Changsha Central Hospital,University of South China),Changsha 410018,Hunan,China;Department of Orthopedics,Xiangya Hospi-tal,Central South University,Changsha 410008,Hunan,China)

机构地区：[1]长沙市中心医院(南华大学附属长沙中心医院)骨科,湖南长沙410018 [2]中南大学湘雅医院骨科,湖南长沙410008

出　　处：《中国现代手术学杂志》2021年第5期371-375,共5页Chinese Journal of Modern Operative Surgery

基　　金：湖南省卫生健康委科研计划项目(20201902)。

摘　　要：目的探讨关节镜下应用可调节带袢锁扣钢板全内重建后交叉韧带断裂的方法和效果。方法对23例后交叉韧带断裂患者取同侧半腱肌腱,关节镜下采用全内技术重建后交叉韧带,移植肌腱两端行可调节带袢锁扣钢板悬吊固定。应用IKDC、Lysholm评分进行临床疗效及膝关节功能评价。结果本组23例患者均获得随访,时间12~24个月。手术切口均愈合良好,无一例感染。术后发生肌间静脉血栓1例,同侧小腿取腱部位周围皮肤麻木1例。术后患者膝关节不稳症状均得到明显改善,后抽屉实验均为阴性,膝关节主被动活动范围均明显改善,主动活动度由10°~80°升至90°~110°,被动活动度由30°~90°升至100°~120°。末次随访,IKDC分级为A级15例,B级8例,Lysholm评分80~95,平均(88.91±3.976)分,均较术前明显改善,差异均有统计学意义(P<0.01)。患者术后常规复查X线及CT示骨道位置良好,带袢钢板贴合紧密,无松动。结论关节镜下应用可调节带袢锁扣钢板全内重建后交叉韧带是一种安全、有效的治疗方法,具有取腱用量少、最大限度保留骨量、固定稳定及移植肌腱张力满意的优点。Objective To investigate the method and efficacy of the arthroscopic posterior cruciate ligament(PCL)all-inside reconstruction with adjustable tight-rope devices.Methods 23 patients with PCL rupture were performed arthroscopic all in-side reconstruction with same semitendinosus tendon autograft,both ends of transplanted tend were suspended and fixed by adjustable tight-rope devices.IKDC grading and Lysholm knee score were used to evaluate the clinical outcome and knee joint function.Results All cases were followed up for 12 to 24 months.The incision healed well without infection in all 23 cases.Intermuscular venous thrombosis was found in one case and ipsilateral skin numbness around the donor tendon of the leg in 1 case.After the surgery,the posterior drawer test showed negative,and the symptoms of knee instability and the range of active-passive motion of knee joint were improved significantly(the range of active motion improved from 10°~80°to 90°~110°and the passive motion improved from 30°~90°to 100°~120°).At the last follow-up,the IKDC graded A in 15 cases and grade B in 8 cases,and Lysholm scored(88.91±3.976)averagely(ranged from 80 to 95).Both IKPC grade and Lysholm score were improved remarkable than those before the operation,and all the differences were statistically significant(P<0.01).X-ray and CT showed that the position of bone tunnel was satisfied,and the adjustable plate with loop buckle fitted tightly without loosening.Conclusion The arthroscopic PCL all-inside reconstruction with adjustable tight-rope devices is a safe and effective treatment for PCL rup-ture with advantages of less tendons removal,maximum bone reservation,satisfactory stable fixation and opti-mal grafting tendon tension.

关 键 词：后交叉韧带损伤 半腱肌腱 全内重建 可调节带袢锁扣钢板 

分 类 号：R686.5[医药卫生—骨科学]