微创医学

目的探讨用髌腱复合体和腘绳肌腱联合重建膝关节膝前、后交叉韧带复合损伤手术方法和手术疗效。方法确诊为前、后交叉韧带同时损伤的患者16例,其中合并内侧副韧带损伤6例,后外侧复合体损伤4例,半月板损伤6例,于伤后2～6周在关节镜下行自体移植物单束ACL和PCL联合重建术,用髌腱复合体中1/3重建ACL,腘绳肌腱重建PCL,同期用股二头肌腱的1/3重建PLC,界面可吸收挤压螺钉和横穿钉固定。结果术后随访13～28个月,平均23个月,术前Lysholm膝关节评分为0～22分,平均(8.7±3.1)分,术后升至78～91分(平均86.1±4.8分)。术前16例采用国际膝关节文件编制委员会(IKDC)综合评定为异常(C级),术后改进为随访时正常(A级)14例,接近正常(B级)2例,14例恢复伤前运动水平。术后6～8个月基本恢复正常工作和生活,12个月可以剧烈运动。结论关节镜下自体肌腱同时联合重建膝前、后交叉韧带能较好地恢复膝关节的稳定性和功能。

Objective To explore the technique and outcome of procedure of B-PT-B， semitendinosus / gracili tendons for combined reconstruction of anterior cruciate ligament ( ACL) and posterior cruate ligament ( PCL) ． Method Sixteen diagnosed patients of ACL and PCL were enrolled，including 6 MCL patients，4 PLC patients，and 10 meniscus patients ． Patients were reconstructed of combined ACL and PCL under arthroscopy 2 － 6 weeks after injury． 1 /3 of Autogenous B-PT-B was performed only for ACL，hamstring combined autogenous semitendinosus /gracili tendons only for PCL． The interface was fixed with absorbable crushing screw and crossing nail． Results All patients were followed up for a mean of 13 － 28 months( averaging 23 months) ． According to the Lysholm rating systems，the scores were 0 － 27( average 8． 9) preoperatively，and improved to 78 － 91 ( average 86． 1 ) postoperatively． Based on the International Knee Documentation Committee( IKDC) evaluation，16 patients were classified as abnormal ( grade C) before operation，while after operation，14 patients were classified as normal ( grade A ) ，2 as close to normal ( grade B ) ． Conclusion Combined reconstruction of ACL and PCL with autogenous tendons under arthroscopy can recover stabilization and function of knee．