关节镜下穿残段正中重建后交叉韧带的早期疗效观察

Early efficacy of arthroscopic posterior cruciate ligament reconstruction with tendon through remnant fiber slit

摘要:

目的 介绍肌腱穿残段正中劈裂缝后交叉韧带（PCL）的镜下重建手术方法，评估术后膝关节功能及本体感觉恢复情况。方法 2012年8月-2014年3月，17例符合入选标准的PCL损伤患者采用了穿残段正中劈裂缝的PCL镜下解剖单束式重建手术，术中以悬吊钢板和生物可吸收挤压螺钉为肌腱固定方式。对患者术前及术后12个月的Lysholm及国际膝关节文献委员会（IKDC）的主观评分和KT-1000（关节活动测量仪，PMENT NO 4.563 555，MEDmetric Corporation，San Diego，California，美国）测量值对照来评估膝关节功能恢复情况，对照患者术后12个月的双膝被动重新定位（PRP）值及被动运动察觉阈值（TTDPM）评估膝关节本体感觉。结果 所有患者在12个月的随访期内均无严重并发症出现。主观评分结果显示：Lysholm评分从平均（54.41±8.00）分增高到随访12个月后的（90.12±2.69）分（P <0.05）；IKDC膝关节功能评分从术前平均（60.29±3.48）分，增加随访后的（87.00±1.46）分（P <0.05），所有患者均达到受伤前的日常生活水平。客观评分结果显示为：KT-1000术前测量均值（8.71±2.17）mm，随访12个月后测量均值（1.88±0.78）mm，术后12个月的本体感觉测试显示，分别在15°、45°和75°的膝关节PRP均值及45°的TTDPM均值测试与对侧的测试比较，差异均无统计学意义（P >0.05）。结论 采用关节镜下经残段正中劈裂缝PCL保残重建术能够有效地恢复膝关节的稳定性及改善膝关节功能。保留PCL残段与滑膜可能有益于本体感觉的恢复及重建肌腱的愈合。

Abstract:

Objectives To introduce arthroscopic posterior cruciate ligament (PCL) reconstruction with the tendon through the middle gap of remnant fiber and evaluate the recovery of postoperative knee function and the preliminary proprioception. Methods 17 cases of eligible patients of posterior cruciate ligament ruptures were performed arthroscopic Single-beam type anatomical reconstruction with the tendon throung the middle gap of remnant fiber from August 2012 to March 2014. The tendon is fixed in operation through suspension of end-button and extrusion of bioabsorbable interference screw. The recovery of Knee function is assessed with comparative analyzing the preoperative and postoperative Lysholm and The International Knee Documentation Committee knee nation form (IKDC) subjective scores and KT-1000 (Joint stability measuring apparatus, PMENT NO 4.563 555, MEDmetric Corporation, San Diego, California, America) scores, and the postoperative proprioception of knee is assessed through measureing the time threshold to detection of passive motion(TTDPM) and the passive re-positioning (PRP) scores. Results There was no serious complications for all patients during the postoperative 12 month follow-up. Subjective scores showed: Lysholm scores from an average of (54.41 ± 8.00) scores increased to (90.12 ± 2.69) scores for 12 months followed up (P < 0.05); IKDC knee scores from preoperative average (60.29 ± 3.48) scores increased to (87.00 ± 1.46) scores after follow-up (P < 0.05). All patients reached the pre-injury level of daily life. The results appear as objective scores: preoperative KT-1000 measured mean scores(8.71 ± 2.17) mm, followed up 12 months measured the mean scores(1.88 ± 0.78) mm, proprioception tests follow up 12 months showed, the knee PRP mean Angles respectively in 15°, 45°, 75° and the mean TTDPM Angles test at 45° Compared with the contralateral showed no significant difference (P > 0.05). Conclusion Arthroscopic posterior cruciate ligament reconstruction with tendon throughing remnant fiber can effectively restore the stability of the knee and improve knee function, preserving remnant stubs and synovial of PCL may be beneficial recovery of proprioception and healing of reconstruction tendon.