关节镜下经胫骨“腱钉栓”嵌入式后交叉韧带重建术疗效分析  

Effectiveness analysis of arthroscopic reconstruction of posterior cruciate ligament with embedded “tibial tendon bolt” fixation

作　　者：孙正平 张春雨 廉永云[1] 逯代锋[1] SUN Zhengping;ZHANG Chunyu;LIAN Yongyun;LU Daifeng(Department of Orthopedics,the Fourth Affiliated Hospital of Harbin Medical University,Haerbin Heilongjiang,150001,P.R.China)

机构地区：[1]哈尔滨医科大学附属第四医院骨科,哈尔滨150001

出　　处：《中国修复重建外科杂志》2022年第4期420-424,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：哈尔滨医科大学附属第四医院科技创新人才基金(HYDSYKJCXRC202123)。

摘　　要：目的 评估关节镜下经胫骨“腱钉栓”嵌入式重建后交叉韧带(posterior cruciate ligament,PCL)的临床效果。方法 回顾性分析2012年2月—2016年4月32例关节镜下应用“腱钉栓”固定体经胫骨“8”字形隧道嵌入式重建PCL患者的临床资料。男23例,女9例;年龄15-57岁,平均39.9岁。交通事故伤12例,运动损伤20例。临床表现:膝关节肿胀,膝关节间隙压痛,后抽屉试验均为(+)Ⅲ度;McMurry试验(+)13例,外翻应力试验(+)8例,Lachman试验(+)9例,Dial试验(+)2例。术前Lysholm评分为(18.8±10.9)分,国际膝关节文献委员会(IKDC)评分为(18.0±15.2)分,KT-1000检测值为(14.34±2.73)mm。受伤至手术时间为8-225 d,中位时间11 d。结果 术后32例患者均获随访,随访时间25-36个月,平均26.4个月。所有患者均无膝关节间隙压痛,且McMurry试验均为(-)。末次随访时,Lysholm评分为(90.2±2.4)分,IKDC评分为(87.2±6.2)分,均较术前显著改善(t=-38.400,P<0.001;t=-27.190,P<0.001)。后抽屉试验(-)21例,(+)Ⅰ度9例,Ⅱ度2例,与术前比较差异有统计学意义(Z=7.507,P<0.001)。术后1年和2年的KT-1000检测值分别为(5.56±2.28)、(5.87±1.78)mm,均较术前显著改善(P<0.05)。结论 关节镜下应用“腱钉栓”固定体经胫骨“8”字形隧道嵌入式重建PCL疗效满意,是一种有效、简便、安全的固定方法。Objective To evaluate the effectiveness of arthroscopic reconstruction of posterior cruciate ligament(PCL) with embedded “tibial tendon bolt” fixation. Methods The clinical data of 32 patients who underwent arthroscopic reconstruction of PCL using embedded “tibial tendon bolt” fixation through the tibial “8”-shaped tunnel between February 2012 and April 2016 were analyzed retrospectively. There were 23 males and 9 females, aged 15-57 years(mean, 39.9 years). The causes included traffic accident injury in 12 cases and sports injury in 20 cases. The clinical manifestations were swelling of knee joint, tenderness of knee joint space, and(+) Ⅲ degree in posterior drawer test;McMurry test(+) in 13 cases, valgus stress test(+) in 8 cases, Lachman test(+) in 9 cases, and Dial test(+) in 2 cases. The preoperative Lysholm score was 18.8±10.9, the International Knee Documentation Committee(IKDC) score was18.0±15.2, and the detection value of KT-1000 was(14.34±2.73) mm. The time from injury to operation was 8-225 days,with a median of 11 days. Results All 32 patients were followed up 25-36 months, with an average of 26.4 months. The patients had no tenderness of joint space, and the McMurry tests were all(-). At last follow-up, the Lysholm score and IKDC score were 90.2±2.4 and 87.2±6.2, respectively, which were significantly improved when compared with preoperative ones(t=-38.400, P<0.001;t=-27.190, P<0.001). The results of posterior drawer test were(-) in 21 cases,(+) Ⅰ degree in 9 cases, and(+) Ⅱ degree in 2 cases. At 1 and 2 years after operation, the detection value of KT-1000 were(5.56±2.28) mm and(5.87±1.78) mm, respectively, which were significantly improved when compared with preoperative values(P<0.05). Conclusion The application of arthroscopic reconstruction of PCL using embedded “tibial tendon bolt” fixation through the tibial “8”-shaped tunnel is an effective, simple, and safe surgical procedure.

关 键 词：膝关节 关节镜 后交叉韧带损伤 韧带重建 

分 类 号：R687.4[医药卫生—骨科学]