可调节带袢锁扣钛板-自体半腱肌肌腱全内重建前交叉韧带断裂的效果
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摘要
目的探讨可调节带袢锁扣钛板-自体半腱肌肌腱全内重建膝关节前交叉韧带(anterior cruciate ligament,ACL)断裂的可行性、优缺点及并发症。方法选择2014-07至2015-07应用可调节带袢锁扣钛板-自体半腱肌肌腱全内重建膝关节ACL断裂47例。2~6周,关节镜下应用可调节带袢锁扣钛板-自体半腱肌肌腱全内重建膝关节ACL断裂,伴发内侧副韧带损伤,用股薄肌肌腱修复或直接缝合。取同侧半腱肌肌腱,修整后将肌腱移植物对折成4股,并与可调节带袢锁扣钛板相连,移植物长度为6~6.5 cm,直径为7~9 mm。在ACL胫骨侧、股骨侧印迹定位并用倒打钻钻孔,制作骨隧道,经前内侧入路将肌腱移植物牵入骨道,并两侧逐步锁紧线环,将胫骨向后复位,将钛板固定在骨皮质上。根据重建手术前、后膝关节前抽屉实验、Lachman试验、侧方挤压实验、IKDC膝关节功能评价表、Lysholm评分对患者进行主观和客观评分,以评定疗效。结果本组47例随访2~3年,平均随访时间为2.1年。末次随访时,患者膝关节疼痛、肿胀、屈伸活动受限等症状明显改善,前抽屉实验(-),Lachman试验(-),IKDC膝关节功能评分、Lysholm评分较重建前明显提高。膝关节屈曲达115°~130°;膝关节IKDC评分结果:正常41例(87.2%),接近正常4例(8.5%),异常2例(4.3%);膝关节功能Lysholm评分:术前(51.4±5.4)分,术后(92.2±4.6)分,差异有统计学意义(P<0.05)。结论应用可调节带袢锁扣钛板-自体半腱肌肌腱全内重建膝关节ACL,创伤小,能恢复膝关节的稳定性,功能恢复良好,疗效确切。
Objective To study the feasibility and relative merits of reconstructing the anterior cruciate ligament injuries with autologous semitendinosus tendon using adjustable TightRope all inside,and its complications. Methods Forty-seven patients who suffered from anterior cruciate ligament injuries were referred to our department between July 2014 and July 2015. In 2-6 weeks,the broken ACL was reconstructed with autologous semitendinosus tendon using adjustable TightRope all inside. The medial collateral ligament damage was repaired or directly sutured with the gracilis tendon. The repaired semitendinosus graft was folded twice into portions of 6-6. 5 cm by 7-9 mm,and was then linked with the adjustable TightRope device. The femoral and tibial socket preparation was made by retrograde drilling at the ACL print foot. The tendon graft was pulled into the bone tunnel through the anterior-medial port,the adjustable tight loop was locked step by step from two sides,and the titanium plate was fixed on the cortex of the bone. Those patients who were complicated with medial collateral ligament injuries were fixed with ipsolateral gracilis tendon. The anterior Drawer test,Lachman test,IKDC classification,Lysholm scores were calculated before and after surgery to evaluate the efficacy of reconstruction. Results These patients who had been treated surgically were followed up for 2 to 3 years,averaging 2. 1 years. All their preoperative symptoms were effectively alleviated in the last follow-up,such as the pain of knees,swelling and limitation of range of motion. The anterior drawer test(-),the Lachman test(-),IKDC classification,and Lysholm scores after reconstruction were significantly increased( P < 0. 05). The range of motion of knees was 115°-130°. As for the knee IKDC score: 41 patients were rated normal( 87. 2%),4 patients nearly normal( 8. 5%),and2 patients abnormal( 4. 3%). The rate of normal and nearly normal scores was 95. 7%. The knee function Lysholm score was( 51. 4 ±5. 4) points before operation,and( 92. 2 ± 4. 6) points after operation,so the difference was of statistical significance( P < 0. 05).Conclusions Reconstructing the anterior cruciate ligament injuries with autologous semitendinosus tendon using adjustable TightRope all inside can recover the stability and function of knees,with remarkable short and medium-term efficacy.
Objective To study the feasibility and relative merits of reconstructing the anterior cruciate ligament injuries with autologous semitendinosus tendon using adjustable TightRope all inside,and its complications. Methods Forty-seven patients who suffered from anterior cruciate ligament injuries were referred to our department between July 2014 and July 2015. In 2-6 weeks,the broken ACL was reconstructed with autologous semitendinosus tendon using adjustable TightRope all inside. The medial collateral ligament damage was repaired or directly sutured with the gracilis tendon. The repaired semitendinosus graft was folded twice into portions of 6-6. 5 cm by 7-9 mm,and was then linked with the adjustable TightRope device. The femoral and tibial socket preparation was made by retrograde drilling at the ACL print foot. The tendon graft was pulled into the bone tunnel through the anterior-medial port,the adjustable tight loop was locked step by step from two sides,and the titanium plate was fixed on the cortex of the bone. Those patients who were complicated with medial collateral ligament injuries were fixed with ipsolateral gracilis tendon. The anterior Drawer test,Lachman test,IKDC classification,Lysholm scores were calculated before and after surgery to evaluate the efficacy of reconstruction. Results These patients who had been treated surgically were followed up for 2 to 3 years,averaging 2. 1 years. All their preoperative symptoms were effectively alleviated in the last follow-up,such as the pain of knees,swelling and limitation of range of motion. The anterior drawer test(-),the Lachman test(-),IKDC classification,and Lysholm scores after reconstruction were significantly increased( P < 0. 05). The range of motion of knees was 115°-130°. As for the knee IKDC score: 41 patients were rated normal( 87. 2%),4 patients nearly normal( 8. 5%),and2 patients abnormal( 4. 3%). The rate of normal and nearly normal scores was 95. 7%. The knee function Lysholm score was( 51. 4 ±5. 4) points before operation,and( 92. 2 ± 4. 6) points after operation,so the difference was of statistical significance( P < 0. 05).Conclusions Reconstructing the anterior cruciate ligament injuries with autologous semitendinosus tendon using adjustable TightRope all inside can recover the stability and function of knees,with remarkable short and medium-term efficacy.
引文
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[7]Ebrahimzadeh M H,Makhmalbaf H,Golhasani-Keshtan F,et al.The International Knee Documentation Committee(IKDC)subjective short form:a validity and reliability study[J].Knee Surg Sports Traumatol Arthrosc,2015,23(11):3163-3167.
[8]Tay K S,Hwee A,Tan C.Clinical outcomes,return to sports,and patient satisfaction after anterior cruciate ligament reconstruction in young and middle-aged patients in an asian population-a 2-year follow-up study[J].Arthroscopy,2017,26(10):339-345.
[9]Persson A,Gifstad T,Lind M,et al.Graft fixation influences revision risk after ACL reconstruction with hamstring tendon autografts[J].Acta Orthop,2017,3(11):446-453.
[10]Mousavi H,Maleki A,Nobakht A.Comparative study after hamstring anterior cruciate ligament reconstruction with endobutton and rigidfix:a clinical trial study[J].Adv Biomed Res,2017,6(2):136-141.
[2]Kim H S,Seon J K,Jo A R.Current trends in anterior cruciate ligament reconstruction[J].Knee Surg Relat Res,2013,25(4):165-173.
[3]Vaishya R,Agarwal A K,Ingole S,et al.Current trends in anterior cruciate ligament reconstruction:a review[J].Cureus,2015,7(11):378-382.
[4]Sonnery-Cottet B,Panisset J C,Colombet P,et al.Partial ACL reconstruction with preservation of the posterolateral bundle[J].Orthop Traumatol Surg Res,2012,98(8):165-170.
[5]Ardern C L,Taylor N F,Feller J A,et al.Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery:an updated systematic review and meta-analysis including aspects of physical functioning and contextual factors[J].Br J Sports Med,2014,48(21):1543-1552.
[6]Fetto J F,Marshall J L.Medial collateral ligament injuries of the knee:a rationale for treatment[J].Clin Orthop Relat Res,1978,132:206-218
[7]Ebrahimzadeh M H,Makhmalbaf H,Golhasani-Keshtan F,et al.The International Knee Documentation Committee(IKDC)subjective short form:a validity and reliability study[J].Knee Surg Sports Traumatol Arthrosc,2015,23(11):3163-3167.
[8]Tay K S,Hwee A,Tan C.Clinical outcomes,return to sports,and patient satisfaction after anterior cruciate ligament reconstruction in young and middle-aged patients in an asian population-a 2-year follow-up study[J].Arthroscopy,2017,26(10):339-345.
[9]Persson A,Gifstad T,Lind M,et al.Graft fixation influences revision risk after ACL reconstruction with hamstring tendon autografts[J].Acta Orthop,2017,3(11):446-453.
[10]Mousavi H,Maleki A,Nobakht A.Comparative study after hamstring anterior cruciate ligament reconstruction with endobutton and rigidfix:a clinical trial study[J].Adv Biomed Res,2017,6(2):136-141.