关节镜下六股自体腘绳肌腱胫骨双隧道重建膝前交叉韧带.doc

关节镜下六股自体腘绳肌腱胫骨双隧道重建膝前交叉韧带 李卫平 黄建荣 沈慧勇 宋斌 宋富强 宋洋 广州中山大学附属第二医院骨科，广东省广州市 510120 [摘要]：目的 介绍关节镜下采用六股“人”字形自体腘绳肌腱经胫骨双隧道重建膝前交叉韧带（ACL）的手术方法以其应用体会。方法：对32例膝关节ACL断裂的患者，取自体股薄肌及半腱肌肌腱反折编织形成六股“人”字形移植物，在关节镜监视下采用胫骨双隧道、股骨单隧道界面螺钉固定行ACL重建，观察此方法的可靠性以及近期疗效。同时行半月板部分切除成形术17例、大部分切除术2例，修补术2例；软骨损伤病灶修整6例，内侧副韧带修补3例。结果 ：30例患者获得随访，随访时间7~22个月，平均 14个月。关节活动度均正常，平均Lysholm评分由术前62.0分提高到93.2分，差异有统计学意义( t=2.469，p<0.01)，KT-1000测定平均移动度1.3±0.4mm；复查MRI显示胫骨骨隧道扩大2例，前内侧束髁间窝撞击4例；所有患者的X线照片未见明显关节间隙改变。结论：关节镜下应用六股自体腘绳肌腱经胫骨双隧道、股骨单隧道界面挤压螺钉固定重建ACL的方法创伤少，能最大限度恢复ACL的解剖重建，近期疗效佳。 [关键词] 膝关节 前交叉韧带 重建术 关节镜 Reconstruction anterior cruciate ligament through twin tunnels in tibia use six bundles autoallergic tendons by arthroscope Li weiping; Huang jianrong;Shen huiyong; Song bin;Song fuqiang;Song yang (Department of Orthopedics, The Second Affiliated Hospital , Sun Yat Sen University ,Guangzhou 510120,China) [Abstract]: Objective Introduce the operation method and the comprehension of reconstruction anterior cruciate ligament through arthroscope by using six bundles autoallergic tendons. Method In this 32-patient whose anterior cruciate ligaments were broken, the autoallergic tendon were woven to a flexional six-bundles graft before implant. Twin tunnels in tibia were drilled, the tendon grafts were fixed by screws. All procedures were performed using a standard endoscopic technique.Patial meniscectomy were conducted in 17 casea.Large partial meniscectomy were conducted in 2 cases . Meniscus prosthesis were underwent in 2 cases. Cartilage chipping were underwent in 6 cases. MCL prosthesis were underwent in 3 cases. Results It takes 7 to 22 months 14 in average to follow up 30 patients. The Lysholm score increased from 62.0 to 93.2 averagely, difference is significant( t=2.469，p<0.01). KT-1000 examination shows mean motion is 1.3±0.4mm；MRI callback shows 2 cases has various expanding of the tunnel in tibial tunnel. 4 anteriomedialis bundle had a dash in fossa intercondylica.All cases had no narrowness in joint space in