关节镜下保留残迹的前交叉韧带重建Arthroscopic reconstruction of anterior cruciate ligament with preservation of the remnants
孙磊;田敏;宁廷民;张红;
摘要(Abstract)：
[目的]评估关节镜下保留残迹的前交叉韧带(ACL)重建的技术和效果。[方法]自2005年6月~2006年5月,28例病人(28膝)经关节镜检查证实为ACL断裂,其中8膝伴外侧半月板破裂,6膝伴内侧半月板损伤。关节镜下对原ACL残迹不做切除,采用自体四股绳肌腱,两切口法,单束重建ACL,采用生物可吸收挤压螺钉解剖位固定重建韧带。[结果]本组术后早期均未发生严重并发症。术后随访12~24个月,平均18个月,Lysholm膝关节功能评分由术前46~80分(平均60.75±9.54分),提高至随访时85~100分(平均95.89±6.24分)(P<0.01)。国际膝关节文件编制委员会(IKDC)综合评定由术前异常(C级)19例、显著异常(D级)9例,改进为随访时正常(A级)21例、接近正常(B级)7例。28例患者均恢复伤前运动水平。[结论]关节镜下保留残迹的前交叉韧带重建对关节内干扰小,可能有利于重建韧带血供和神经支配的重新获得,手术操作简捷,术后膝关节功能恢复满意。
关键词(KeyWords)： 膝关节;前交叉韧带;关节镜;保留残迹;四股绳肌腱;单束重建;挤压螺丝钉
基金项目(Foundation):
作者(Author): 孙磊;田敏;宁廷民;张红;
Email:
DOI:
参考文献(References)：
- [1]Murray MM,Martin SD,Martin TL,et al.Histological changes in thehuman anterior cruciate ligament after rupture[J].Bone Joint Surg(Am),2000,82(10):1387-1397.
- [2]Crain EH,Fithian DC,Paxton EW,et al.Variation in anterior cruci-ate ligament scar pattern:does the scar pattern affect anterior laxity in anterior cruciate ligament-deficient knees[J].Arthroscopy,2005,21(1):19-24.
- [3]Falconiero RP,DiStefano VJ,Cook TM.Revascularization and liga-mentization of autogenous anterior cruciate ligament grafts in humans[J].Arthroscopy,1998,4(2):197-205.
- [4]Unterhauser FN,Bail HJ,Hoher J,et al.Endoligamentous revascular-ization of an anterior cruciate ligament graft[J].Clin Orthop Relat Res,2003,414:276-288.
- [5]Howell SM,Knox KE,Farley TE,et al.Revascularization of a human anterior cruciate ligament graft during the first two years of implanta-tion[J].Am J Sports Med,1995,23(1):42-49.
- [6]Ochi M,Iwasa J,Uchio Y,et al.Induction of somatosensory evokedpotentials by mechanical stimulation in reconstructed anterior cruciate ligaments[J].Bone Joint Surg(Br),2002,84(5):761-766.
- [7]Adachi N,Ochi M,Uchio Y,et al.Mechanoreceptors in the anterior cruciate ligament contribute to the joint position sense[J].Acta Or-thop Scand,2002,73(3):330-334.
- [8]Lee BI,Min KD,Choi HS,et al.Arthroscopic anterior cruciate liga-ment reconstruction with the tibial-remnant preserving technique u-sing a hamstring graft[J].Arthroscopy,2006,22(3):340.
- [9]Ochi M,Adachi N,Deie M,et al.Anterior cruciate ligament augmen-tation procedure with a1-incision technique:anteromedial bundle or posterolateral bundle reconstruction[J].Arthroscopy,2006,22(4):463.
- [10]孙磊,宁廷民,田敏,等.关节镜下自体四股腘绳肌腱重建膝前交叉韧带[J].中华创伤杂志,2005,21(5):336-340.