摘要
[目的]介绍关节镜下经前交叉韧带(anterior cruciate ligament, ACL)腋下胫骨定位的后交叉韧带(posterior cruciate ligament, PCL)重建术的技术及初步疗效。[方法] 2016年3月~2018年11月,对20例后交叉韧带断裂患者采用关节镜下经ACL腋下定位胫骨骨道,保残重建后交叉韧带。术中保留PCL残束,经前入路由内向外建立PCL股骨隧道,经ACL腋下置入胫骨隧道定位器,在后内入口观察下,于PCL止点平台下建立胫骨隧道。将移植腱由胫骨前侧经胫骨隧道拉入、再引入股骨隧道,股骨侧悬吊固定,拉紧移植物,胫骨侧挤压螺钉和"n"形钉固定。[结果]所有患者均顺利手术,无严重并发症。随访1年以上,Lysholm评分从术前(38.75±14.52)分显著增加至术后1年(93.70±4.23)分(P<0.05)。影像测量后向应力胫骨后移由术前(10.81±3.07) mm减少至术后1年(3.86±1.10) mm (P<0.05)。[结论]经ACL腋下定位胫骨骨道重建PCL,能精确的偏下偏外定位胫骨骨道;并可以最大程度的保留PCL残端,有利于重建术后韧带的愈合。
[Objective] To introduce the surgical technique and preliminary clincal outcomes of tibial tunnel location under anterior cruciate ligament(ACL) in full-arthroscopic reconstruction of posterior cruciate ligament(PCL). [Methods] From March 2016 to November 2018, a total of 20 patients received full-arthroscopic PCL reconstruction in our hospital. During arthroscopic operation the remannat of torn PCL was preserved. The femoral tunnel was created inside-out from the anterior portals. After the guider was placed under ACL from the anteromedial port to the tibial insertion under the plateau, the tibial tunnel was made under arthroscopic vision though the postomedial portal. The tendon graft was introduced from tibia anterior, through the tibial tunnel and femoral tunnel, subsequently fastened at femoral side by suspending fixation, whereas at tibial side by interference screw and a staple under proper tension. [Results] All the patients had arthroscopic procedures finished successfully without serious complications, and were followed up for more than 1 year. The Lysholm score significantly increased from(38.75±14.52) before operation to(93.70±4.23) at 1 year after operation(P<0.05). The posterioe translation of the tibia revealed on images under posterior stress significantly decreased from(10.81±3.07) mm preoperatively to(3.86±1.10) mm at 1 year postoperatively(P<0.05). [Conclusion] This tibial tunnel location under ACL has advantages of accurate location PCL tibial insertion with complete remnant preservation, which facilitates the tendon graft healing.
作者
韦钊岚
韦朝喜
于波
谢能峰
管林冲
彭伟秋
李富明
WEI Zhao-lan;WEI Chao-xi;YU Bo;XIE Neng-feng;GUAN Lin-chong;PENG Wei-qiu;LI Fu-ming(Department of Sports Medicine and Joint Surgery,Pepole's Hospital of Liuzhou 545000,Guangxi,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2021年第4期350-352,356,共4页
Orthopedic Journal of China
关键词
后交叉韧带重建
关节镜
保残
前交叉韧带腋下胫骨骨道定位通路
posterior cruciate ligament(PCL)reconstruction
arthroscopy
remnant preservation
under anterior cruciate ligament(ACL)tibial guider placement
