摘要
目的探讨关节镜下三隧道股骨端带鞘挤压钉（Femoral—Intrafix）固定双束重建前十字韧带（anterior cruciate ligament，ACL）手术方法的可靠性和近期疗效。方法回顾性分析2010年10月至2013年10月采用关节镜下三隧道Femoral—Intrafix固定双束重建30例ACL损伤患者，男18例，女12例；年龄17~45岁，平均28．6岁；左膝12例，右膝18例；运动伤14例，车祸伤16例；急性损伤19例，陈旧性损伤11例。移植物均使用自体胭绳肌腱，股骨端采用Femoral．Intrafix固定系统，胫骨端采用Milagro Interference Screw双隧道挤压固定。术后分别采用国际膝关节评分委员会（Intemational Knee Documentation Committee，IKDC）和Lysholm评分评价主观膝关节功能，应用Lachman和Pivot—shift试验及KT-1000测量客观评估膝关节稳定性。结果30例患者均获得随访，随访时间18～36个月，平均（24．71±1．60）个月，术后无一例发生固定钉脱落、下肢深静脉血栓、移植物再断裂及关节感染。末次随访时Lachman征I度阳性1例，其余患者前抽屉试验、轴移试验及Lachman征均为阴性；30例患者关节活动度正常。Lysholm评分、IKDC评分分别由术前（67．51±4．92）分和（62．31±5．45）分提高到末次随访时（96．41±6.31）分和（95．61±6．32）分，手术前后比较差异均有统计学意义。IKDC评分，优23例，良5例，可2例，优良率93．3％（28／30）。末次随访时膝关节稳定性较术前明显改善，术前屈膝30°时KT-1000为（7．62±1．25）mm，屈膝90°时为（5．43±1．21）mm；末次随访时KT-1000屈膝30。时为（1．53±1．02）mm，屈膝90。时为（1．07±1．02）mm。结论关节镜下三隧道Femoral—Intrafix固定双束重建ACL是一种可靠方法，手术操作简单，术后内固定牢固，近期疗效满意。
Objective To investigate the results of arthroscopic anterior cruciate ligament anatomic reconstruction using three-tunnel double-bundle methods with Femoral-lntrafix system. Methods From October 2010 to October 2013, data of 30 cas- es of arthroscopic anterior cruciate ligament （ACL） reconstruction who were randomly used with Femoral-Intrafix system were retro- spectively analyzed. Hamstring tendons autograft were used for all patients. The Femoral-Intrafix system fixation was used for the femoral tunnel and the Milagro interference screw was used for tibia1 tunnels. KT- 1000 arthrometer measurements, Laehman and Pivot-shift tests, and knee function with the International Knee Documentation Committee （IKDC）, Lysholm scores were used for clinical evaluation. Results All the patients were followed up for an average time of 24.71±1.60 months （range, 18-36 months）. No patients had ligament re-rupture, deep vein thrombosis, exfliation of interference screw, joint pain and limited mobility during follow-up period. At the latest follow-up, the Lachman sign was I degrees positive in 1 patient, and all patients had normal range of motion. The Lysholm scores increased from preoperative 67.51±4.92 to 96.41±6.31 at the latest follow up. The IKDC scores in- creased from preoperative 62.31±5.45 to 95.61±6.32 at the latest follow up. There was 93.3% excellent and good rate, including excellent in 23 cases, good in 5 cases, and fair in 2 cases according to the IKDC. All knee function scores were improved. The re- sults of KT-1000 were improved significantly （7.62±1.25 mm vs. 1.53±1.02 mm at 30° of flexion, 5.43±1.21 mm vs 1.07±1.02 mm at 90° of flexion） at the tensile fore of 134 N. Conclusion Arthroscopic ACL reconstruction using three-tunnel double-bundle methods with the Femoral-Intrafix system fixation is a reliable technique, which is easy to operate and has satisfactory short clini- cal outcome for knee function recovery.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2018年第1期38-45,共8页
Chinese Journal of Orthopaedics
关键词
关节镜检查
前十字韧带重建
移植
自体
Arthroscopy
Anterior cruciate ligament reconstruction
Transplantation, autologous
