关节镜下股四头肌腱—髌骨块重建后交叉韧带
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摘要
目的:设计关节镜下利用股四头肌腱—髌骨块嵌入挤压固定方法重建后交叉韧带(PCL),观察其治疗PCL损伤的疗效。方法:自2002年6月～2006年12月,对33例PCL损伤患者采用关节镜下利用股四头肌腱—髌骨块嵌入和可吸收螺钉。挤压固定方法重建后交叉韧带。股四头肌腱移植物的获取中保证髌骨上极和股四头肌腱条的连接;股骨隧道制作好以后;股四头肌腱移植后将与之连接的髌骨块拉紧嵌入股骨隧道并用可吸收螺钉挤压固定,胫骨隧道内用可吸收螺钉挤压固定移植肌腱,并将牵引线捆绑于螺丝钉固定于胫骨上。治疗效果采用Lysholm评分和国际膝关节文献委员会(IKDC)的分级标准评定。结果:所有患者获得3～37个月(平均19个月)随访,无患者发生血管神经损伤及移植物失败等严重并发症。所有患者均无膝关节不稳定症状,除2例患者剧烈活动后关节疼痛外,其余患者关节疼痛症状明显缓解。Lysholm评分术后高于术前,差异有显著性意义(P＜0.01);IKDC评定结果明显优于术前。结论:采用股四头肌腱移植物对取材部位无不良影响,移植物生物力学特性更接近PCL,且可以切取任意长度和宽度,保证远大于PCL的强度.移植物固定采用本设计的骨块嵌入和可吸收螺钉挤压的方法,成功率高、并发症少,有明显优越性。
Objective:To discuss the design of arthroscopic reconstruction of posterior cruciate ligament(PCL)with quadriceps tendon fixed by a patellar block,and its clinical outcome.Methods:Thirty-threes patients suffering from PCL injury were treated by the technique mentioned above.The connection between quadriceps tendon and superior patellar pole was preserved in the havest process of quadriceps tendon,the femoral tunnel was a small tunnel,about 10～11mm wide,which was clogged with the patellar bone block.The quadriceps tendon strip was fixed by an absorble screw into the tibial tunnel. their functional recovery,was evaluated by Lysholm scoring and IKDC(International Knee Documentation Committee)criteria.Results:In the average follow-up period of 19 months,there were not any severe nerve or blood vessel lesions,or failures of transplanted ligament.None of the patents complained of knee instability after the opration.The pain was relieved in most patients,but three complained of pain after knee movement.A little calcification was found in the quadriceps tendon at the superior patellar one year after the opration in the X-ray of a patient,three was significant difference in Lysholm scale between pre-opration and post-opration(p＜0.01).their IKDC evaluation before opration significantly improved after opration.Conlusions:quadriceps tendon harvest may have little influence on the donor area.And quadriceps tendon is similar to PCL in biomechanics and can be harvested in any length and width needed so as to provide more strength than PCL.As a result,arthroscopic PCL reconstruction with quadriceps tendon fixed by a patellar block can be done with a high success rate and few complication.
Objective:To discuss the design of arthroscopic reconstruction of posterior cruciate ligament(PCL)with quadriceps tendon fixed by a patellar block,and its clinical outcome.Methods:Thirty-threes patients suffering from PCL injury were treated by the technique mentioned above.The connection between quadriceps tendon and superior patellar pole was preserved in the havest process of quadriceps tendon,the femoral tunnel was a small tunnel,about 10～11mm wide,which was clogged with the patellar bone block.The quadriceps tendon strip was fixed by an absorble screw into the tibial tunnel. their functional recovery,was evaluated by Lysholm scoring and IKDC(International Knee Documentation Committee)criteria.Results:In the average follow-up period of 19 months,there were not any severe nerve or blood vessel lesions,or failures of transplanted ligament.None of the patents complained of knee instability after the opration.The pain was relieved in most patients,but three complained of pain after knee movement.A little calcification was found in the quadriceps tendon at the superior patellar one year after the opration in the X-ray of a patient,three was significant difference in Lysholm scale between pre-opration and post-opration(p＜0.01).their IKDC evaluation before opration significantly improved after opration.Conlusions:quadriceps tendon harvest may have little influence on the donor area.And quadriceps tendon is similar to PCL in biomechanics and can be harvested in any length and width needed so as to provide more strength than PCL.As a result,arthroscopic PCL reconstruction with quadriceps tendon fixed by a patellar block can be done with a high success rate and few complication.
引文
posterior cruciate ligaments after traumatic kneedislocation[J].J
Sports Med(AM),1995,23(5):580-587
[13]孙磊,宁志杰,田敏等,急性膝关节后内侧损伤[J].中国矫形外科杂志,2005,13(20):1528-1531
[14]孙磊,宁志杰,田敏等,膝关节后交叉韧带损伤合并后外侧角损伤[J].中国矫形外科杂志,2006
[15]Kulthanan T.Gore-Tex cruciate ligament reconstruction in atheltes.J Med Assoc Thai,1992,75(7):407
[16]Vogel UB.Clinical experiences with the cruciate ligament 5-PTFE (Gore-Tex)prosthesis.More than 4 year follow-up.Helv Chit Acta,1992,58(6):943
[17]Chiu FY,Wu JJ,Hsu HC et al.Management of insufficiency of posterior cruciate ligaments.Chung Hua I Haueh Tsa Chih Taipei,1994,53(5):282
[18]Holtslag HR,Van der Hoeven H,Alting MP.Instability of the distal radio-ulnar joint:stabilization by a Gore-Tex ligament.Plast Reconstr Surg,1999,104(3):699
[19]王亦璁.膝关节韧带损伤的评估.中华骨科杂志,1997,8:536
[1]Fukude H,Hamada K,Yamanaka K.Pathology and pathogenesis of bursar side rotator cuff tears viewed from enbloc histologic sections.Clin Orthop,1990,254:75-79
[2]Bigliani LU,Morrison DS,April EW.rhe morphology of the acromion and its relationship to rotator cuff tear.[J].Ortho Trans,1986,10:216-228
[3]Brooks CH,RevellWS,Heatley FW.A quantitative histological study of the vascularity of the rotator cuff tendon.[J]J Bone Joint Surg(Br),1992,74:151-156
[4]BennettWF.Visualization of the anatomy of the rotator interval and bicip ital Sheath[J].Arthroscopy,2001,17(1):107-111
[5]陈疾忤,陈世益,张鹏.肩袖间隙的解剖学研究及其临床意义[J].中国临床解剖杂志,2004,22(1):55-57
[6]Jost B,kochpp,Gerber C.Anatomy and functional aspects of the rota2tor interval[J].J Shoulder Elbow Surg,2000,9(4):336-341
[7]Cole BJ,Rodeo SA,O' Brien SJ,et al.The anatomy and histology of the rotator interval cap sule of the shoulder[J].Clin Orthop,2001,390:129-137
[8]Fukuda H.Hamada K.Yamanaka K.Pathology and pathogenesis of bursal side rotator cuff tears viewed from En Bloc histologic sections.[J].Clin Orthop.1990,254:75
[9]路奎云,段秀和,徐红兵等,肩袖撕裂的组织学及电子显微镜观察[J].中华外科杂志,1998,36(9>:556-558.
[10]Neer CS Ⅱ,Poppen NK.Supraspinatus outlet.Orthop Trans,1987,11:234-239
[11]Cordasco FA,Bigliani LU.Large and massive tears.Orthop Clin Noth Am,1997,28:179-193
[12]Jane Schein Long.Shoulder arthroscopy.Orthop Nurs,1996,15:21-25
[13]Miniaci A,Salonen D.Rotator cuff evaluation:Imagine and diagnosis.Orthop Clin North Am,1997,28:43-57
[14]Teefey SA,Middleton WD,Yamaguchi K.Shoulder sonography:state of theart.Radiol Clin North Am,1999,37:767285
[15]林发俭,崔国庆,张武,等.肩袖撕裂的超声诊断.中国超声医学杂志,2001, 14:2242226
[16]Hong Jenchiou,Chung Chuenhsu,Yi Hongchou,et al.Sonographic signs ofcomplete rotator cuff tears.Chin Med J(Taipei),1996,58:4282434
[17]林发俭,崔国庆,张武,等.肩袖撕裂的超声诊断.中国超声医学杂志,2001,14:2242226
[18]Miniaci A,Salonen D.Rotator cuff evaluation:Imagine and diagnosis.Orthop Clin North Am,1997,28:43-57
[19]rotator cuff.A comparison of ultrasonographic and arthroscop ic findings in one hundred consecutive cases[J].J Bone Joint Surg(Am).2000,82:498-504
[20]Martin-Hervas C,Romero J,Navas-Aclen A,et al.Ultrasonographic and magnetic resonance images of rotator cuff lesion compared with arthroscopy or open surgery findings[J].J Shoulder Elbow Surg.2001,10:410-415
[21]董蓓莉,侯效民,急性创伤致肩袖撕裂的超声诊断[J].中华超声影像学杂志.2003,12(11):684-687
[22]Sharlene A,Teefey,William,et al.Shoulder sonography:Statte and Art.Radio l Clin N Am,1999,37:765-785
[23]M arc G,Soble,Alan D,et al.Rotator cuff tear:Clinical experience with sonographic detection.Radio fogy,1989,173:319-321
[24]Miniaci A,Salonen D.Rotator cuff evaluation:Imagine and diagnosis.Orthop Clin North Am,1997,28:43-57
[25]郭艾,藤田健司,水野耕作,肩袖损伤诊断中肩关节造影和MR I的敏感性和特异性比较[J].中华外科杂志,2000,38(4):263-265
[26]Neer CS Ⅱ,Poppen NK.Supraspinatus outlet.Orthop Trans,1987,11:234-239
[27]Cordasco FA,Bigliani LU.Large and massive tears.Orthop Clin Noth Am,1997,28:179-193
[28]Miniaci A,Salonen D.Rotator cuff evaluation:Imagine and diagnosis.Orthop Clin North Am,1997,28:43-57
[29]Quinn SF,Sheley RC,Demlow TA,et al.Rotator cuff tendow tears:Evaluation with fat2suppressed MR imaging with arthroscopic correlation in 100patients.Radiology,1995,195:497
[30]Farley TE,Neumann CH,Steinbach LS,et al.Full2thickness tears of the rotator cuff of the shoulder:Diagnosis with MR imaging.AJR,1992, 158:347
[31]刘玉杰,卢世璧.肩袖损伤的诊断和治疗进展.中华创伤杂志,1998,14:3402342
[32]刘玉杰,王志刚,王岩,等.肩袖损伤的影像学及关节镜诊疗价值.中华创伤杂志,2004,20:33235
Sports Med(AM),1995,23(5):580-587
[13]孙磊,宁志杰,田敏等,急性膝关节后内侧损伤[J].中国矫形外科杂志,2005,13(20):1528-1531
[14]孙磊,宁志杰,田敏等,膝关节后交叉韧带损伤合并后外侧角损伤[J].中国矫形外科杂志,2006
[15]Kulthanan T.Gore-Tex cruciate ligament reconstruction in atheltes.J Med Assoc Thai,1992,75(7):407
[16]Vogel UB.Clinical experiences with the cruciate ligament 5-PTFE (Gore-Tex)prosthesis.More than 4 year follow-up.Helv Chit Acta,1992,58(6):943
[17]Chiu FY,Wu JJ,Hsu HC et al.Management of insufficiency of posterior cruciate ligaments.Chung Hua I Haueh Tsa Chih Taipei,1994,53(5):282
[18]Holtslag HR,Van der Hoeven H,Alting MP.Instability of the distal radio-ulnar joint:stabilization by a Gore-Tex ligament.Plast Reconstr Surg,1999,104(3):699
[19]王亦璁.膝关节韧带损伤的评估.中华骨科杂志,1997,8:536
[1]Fukude H,Hamada K,Yamanaka K.Pathology and pathogenesis of bursar side rotator cuff tears viewed from enbloc histologic sections.Clin Orthop,1990,254:75-79
[2]Bigliani LU,Morrison DS,April EW.rhe morphology of the acromion and its relationship to rotator cuff tear.[J].Ortho Trans,1986,10:216-228
[3]Brooks CH,RevellWS,Heatley FW.A quantitative histological study of the vascularity of the rotator cuff tendon.[J]J Bone Joint Surg(Br),1992,74:151-156
[4]BennettWF.Visualization of the anatomy of the rotator interval and bicip ital Sheath[J].Arthroscopy,2001,17(1):107-111
[5]陈疾忤,陈世益,张鹏.肩袖间隙的解剖学研究及其临床意义[J].中国临床解剖杂志,2004,22(1):55-57
[6]Jost B,kochpp,Gerber C.Anatomy and functional aspects of the rota2tor interval[J].J Shoulder Elbow Surg,2000,9(4):336-341
[7]Cole BJ,Rodeo SA,O' Brien SJ,et al.The anatomy and histology of the rotator interval cap sule of the shoulder[J].Clin Orthop,2001,390:129-137
[8]Fukuda H.Hamada K.Yamanaka K.Pathology and pathogenesis of bursal side rotator cuff tears viewed from En Bloc histologic sections.[J].Clin Orthop.1990,254:75
[9]路奎云,段秀和,徐红兵等,肩袖撕裂的组织学及电子显微镜观察[J].中华外科杂志,1998,36(9>:556-558.
[10]Neer CS Ⅱ,Poppen NK.Supraspinatus outlet.Orthop Trans,1987,11:234-239
[11]Cordasco FA,Bigliani LU.Large and massive tears.Orthop Clin Noth Am,1997,28:179-193
[12]Jane Schein Long.Shoulder arthroscopy.Orthop Nurs,1996,15:21-25
[13]Miniaci A,Salonen D.Rotator cuff evaluation:Imagine and diagnosis.Orthop Clin North Am,1997,28:43-57
[14]Teefey SA,Middleton WD,Yamaguchi K.Shoulder sonography:state of theart.Radiol Clin North Am,1999,37:767285
[15]林发俭,崔国庆,张武,等.肩袖撕裂的超声诊断.中国超声医学杂志,2001, 14:2242226
[16]Hong Jenchiou,Chung Chuenhsu,Yi Hongchou,et al.Sonographic signs ofcomplete rotator cuff tears.Chin Med J(Taipei),1996,58:4282434
[17]林发俭,崔国庆,张武,等.肩袖撕裂的超声诊断.中国超声医学杂志,2001,14:2242226
[18]Miniaci A,Salonen D.Rotator cuff evaluation:Imagine and diagnosis.Orthop Clin North Am,1997,28:43-57
[19]rotator cuff.A comparison of ultrasonographic and arthroscop ic findings in one hundred consecutive cases[J].J Bone Joint Surg(Am).2000,82:498-504
[20]Martin-Hervas C,Romero J,Navas-Aclen A,et al.Ultrasonographic and magnetic resonance images of rotator cuff lesion compared with arthroscopy or open surgery findings[J].J Shoulder Elbow Surg.2001,10:410-415
[21]董蓓莉,侯效民,急性创伤致肩袖撕裂的超声诊断[J].中华超声影像学杂志.2003,12(11):684-687
[22]Sharlene A,Teefey,William,et al.Shoulder sonography:Statte and Art.Radio l Clin N Am,1999,37:765-785
[23]M arc G,Soble,Alan D,et al.Rotator cuff tear:Clinical experience with sonographic detection.Radio fogy,1989,173:319-321
[24]Miniaci A,Salonen D.Rotator cuff evaluation:Imagine and diagnosis.Orthop Clin North Am,1997,28:43-57
[25]郭艾,藤田健司,水野耕作,肩袖损伤诊断中肩关节造影和MR I的敏感性和特异性比较[J].中华外科杂志,2000,38(4):263-265
[26]Neer CS Ⅱ,Poppen NK.Supraspinatus outlet.Orthop Trans,1987,11:234-239
[27]Cordasco FA,Bigliani LU.Large and massive tears.Orthop Clin Noth Am,1997,28:179-193
[28]Miniaci A,Salonen D.Rotator cuff evaluation:Imagine and diagnosis.Orthop Clin North Am,1997,28:43-57
[29]Quinn SF,Sheley RC,Demlow TA,et al.Rotator cuff tendow tears:Evaluation with fat2suppressed MR imaging with arthroscopic correlation in 100patients.Radiology,1995,195:497
[30]Farley TE,Neumann CH,Steinbach LS,et al.Full2thickness tears of the rotator cuff of the shoulder:Diagnosis with MR imaging.AJR,1992, 158:347
[31]刘玉杰,卢世璧.肩袖损伤的诊断和治疗进展.中华创伤杂志,1998,14:3402342
[32]刘玉杰,王志刚,王岩,等.肩袖损伤的影像学及关节镜诊疗价值.中华创伤杂志,2004,20:33235