半腱肌股薄肌腱打结骨栓嵌入固定镜下重建前交叉韧带的初步观察  

Anterior cruciate ligament reconstruction using semitendinosus and gracilis tendons knot and bone lock-bolt implant fixation under arthroscope

作　　者：刘玉杰[1] 王志刚[1] 王岩[1] 李众利[1] 张文涛[1] 原新成[1] 

机构地区：[1]解放军总医院骨四病区,北京100853

出　　处：《中华创伤杂志》2003年第3期167-169,共3页Chinese Journal of Trauma

基　　金：全军"十五"攻关课题资助项目 (0 1MA12 3)

摘　　要：目的　探讨自体半腱肌、股薄肌腱中间打结、骨栓嵌入挤压固定法在关节镜下重建前交叉韧带 (ACL)的可行性。　方法　 15例前ACL损伤 ,采用自体半腱肌、股薄肌腱中间打结 ,骨栓嵌入挤压固定法镜下重建ACL。半腱肌腱和股薄肌腱预张力后 ,肌腱中间打结嵌入 12mm×6mm骨栓。经ACL导向器打入导针 ,用环钻建立股骨和胫骨隧道。胫骨和股骨隧道下 1 3的直径为 5～ 7mm ,股骨隧道近 2 3为 11mm。将肌腱从股骨隧道的近端经关节腔牵入胫骨隧道 ,将肌腱拉紧、膝关节屈伸活动 2 0次 ,使肌腱结和骨栓完全嵌入瓶颈状股骨隧道内。将 4股肌腱从胫骨隧道和其下方 10mm处分别穿出 ,交叉打结并缝合固定在骨桥上。　结果　 15例患者得到随访 ,关节稳定 ,功能恢复正常。按膝关节疗效评定标准 ,优 11例 ,良 2例 ,可 2例 ,优良率 86.7%。　结论自体肌腱打结骨栓嵌入固定法重建ACL为生物固定 ,创伤小 ,固定可靠 ,费用低 ,有利于愈合 ;可免除金属内固定物 。Objective To study the feasibility of the anterior cruciate ligament (ACL) reconstruction using semitendinosus and gracilis tendons knot and bone lock bolt implant fixation under the arthroscope. Methods Under the arthroscope, 15 cases of the injured ACL were reconstructed by means of semitendinosus and gracilis tendons knot and bone lock bolt implant fixation. A knot was tied in the medial part of the tendons and one bone lock bolt of 12 mm×6 mm was inserted after preliminary tension of semitendinosus and gracilis tendons. The tunnels of femur and tibia were prepared by using trephine under ACL guider. The diameter of the funnel 1/3 inferior to the femur and tibia was 5 7 mm and that 2/3 superior to the spine 11 mm. The tendon from the lateral side of femur tunnel was inserted into tibial tunnel followed by a kneebend in full extension and flection for 20 times so that the tendon knots and bone lock bolts were absolutely inserted into the bottleneck like femur tunnel. A hole was drilled 10 mm distal to tibia tunnel exit and 4 tendons were crossly knotted and fixed onto a bone bridge using curved clamps. Results Fifteen cases followed up showed apparent functional improvement and stable knee joint. Based on the knee functional scales, 11 patients were clinically rated as excellent, 2 good and 2 fair with an exellence rate of 86.7%. Conclusions As a biological fixation for ACL reconstruction, semitendinosus and gracilis tendons and bone lock bolt implant fixation has advantages in little trauma, firm fixation, less expense and easy healing. Meanwhile, it is free from metal internal fixators without affecting the MRI examination.

关 键 词：前交叉韧带 关节镜检查 膝关节 肌腱移植 

分 类 号：R687.2[医药卫生—骨科学]