关节镜下保留残束重建前交叉韧带的疗效

目的:评价保留残束重建前交叉韧带治疗前交叉韧带部分束损伤的临床疗效。方法:自2002年1月至2009年12月,采用保留残束重建前交叉韧带57例,其中男39例,女18例;年龄16～49岁,平均28.5岁;左膝33例,右膝24例;运动伤及训练伤40例,交通事故伤7例,生活扭伤10例。前抽屉试验阳性23例,弱阳性6例;Lachman试验阳性19例,弱阳性4例;前抽屉试验和Lachman试验均阳性5例;侧方应力试验(内侧)阳性24例。Rolimeter检查胫骨前移7.5～11.5mm,平均8.7mm。国际膝关节文献委员会评分(IKDC)70.0±7.5,膝关节Lysholm评分68.0±6.3。受伤至手术时间1周～12个月,平均3.1个月。结果:关节镜下前内侧束重建32例,后外侧束重建25例。术后57例均获随访,平均时间22.5个月(13～37个月)。末次随访膝关节活动度达120°～130°,前抽屉试验及Lachman试验均阴性54例,前抽屉试验弱阳性2例,Lachman试验弱阳性1例;术后Rolimeter检查膝关节稳定性良好。术后IKDC评分92.0±4.9,Lysholm评分91.0±3.7,均较术前提高。结论:保留残束重建前交叉韧带,有利于移植物血供建立、胶原纤维爬行替代、本体感觉恢复和膝关节的稳定性。

Arthroscopic reconstruction of anterior cruciate ligament with preservation of the remnant bundle

Objective: To evaluate clinical effects of arthroscopic anterior cruciate ligament (ACL) reconstruction with preservation of the remnant bundle. Methods: From January 2002 to December 2009,57 patients with ACL partial rupture were treated with preservation of the remnant bundle. There were 39 males and 18 females,with an average age of 28.5 years old (ranged,16 to 49 years old). Thirty-three patients had injuries in the left knees,and 24 patients had injuries in the right knees. Forty patients had injuries caused by sports,7 patients had injuries caused by traffic accidents and 10 patients had injuries caused by daily sprain. The anterior drawer test showed positive results in 23 patients,weakly positive results in 6 cases; Lachman test showed positive results in 19 patients,and weakly positive in 4 patients. Both anterior drawer test and Lachman test showed positive results in 5 patients; and valgus stress test (medial) showed positive results in 24 patients. The mean value of Rolimeter measurement was 8.7 mm,(ranged,7.5 to 11.5 mm). The mean International Knee Documentation Committee (IKDC) score was 70.0±7.5 and the Lysholm score was 68.0±6.3. The duration from injury to surgery was 1 week to 12 months,with an average of 3.1 months. Results: There were 32 patients treated with anteromedial bundle reconstruction and 25 patients treated with poterolateral bundle reconstruction. Fifty-seven patients were followed up,and the mean follow-up time was 22.5 months (ranged,13 to 37 months). The anterior drawer test and Lachman test were all negative at 1 month post-operation. At the end of the follow-up,the range of motion of all the knees was 120 to 130 degree. There were 54 patients with negative results of anterior drawer test and Lachman test,1 with weakly positive result of anterior drawer test and 2 with weakly positive results of Lachman test. The measurements of Rolimeter showed excellent stability of the knee. The mean IKDC score was 92.0±4.9 and the mean Lysholm score was 91.0±3.7,which all improved compared to preoperative scores. Conclusion: Arthroscopic reconstruction of anterior cruciate ligament with preservation of the remnant bundle has satisfactory effects on the knee stability,which could increase the angiogenesis and collagen of the ACL and improve the proprioception of the knee.