保留残端纤维重建前交叉韧带对腱骨 界面愈合影响的早期临床研究

Early clinical study of preservation of remnants of anterior cruciate ligament reconstruction on tendon-bone healing

摘要:

目的 探讨关节镜下保留残端纤维重建前交叉韧带对腱骨界面愈合的影响。方法 对48例急性前交叉韧带断裂的患者行关节镜下重建。均采用保留韧带残端纤维的前交叉韧带单束重建，股骨端应用Endo-button钢板固定，胫骨端应用可吸收挤压螺钉固定。术后随访，观察临床治疗效果，通过前抽屉试验、Lachman试验、轴移试验及Lysholm膝关节评分评价术后疗效。结果 术后所有的患者均获得随访，随访时间为12～32个月，平均随访19个月。所有患者前抽屉试验阴性，46例患者Lachman试验阴性，2例Lachman试验度阳性，轴移试验检查所有患者均为阴性。Lysholm膝关节功能评分从术前54.6分改善至92.8分。术后平均10周活动度恢复至100°。复查X线片显示骨隧道愈合满意。结论 采用保留残端纤维的ACL单束重建是一种恢复膝关节稳定性的可靠方法，保留残端纤维有利于腱骨愈合，有利于维持膝关节的稳定性。

Abstract:

【Objective】 To investigate the operative techniques and evaluate the outcome of autogeneic hamstring tendons with preservation of the remnants and the remaining bundle on tendon-bone healing of the fibre single-stranded reconstruction of anterior cruciate ligament (ACL). 【Methods】 48 cases (31 male and 17 female, whose age were between18 and 42 and the average age was 26.3) of ACL rupture were treated with single bundle ACL reconstruction, autogeneic hamstring tendons with preservation of the remnants and the remaining bundle of the fibre single-stranded reconstruction of anterior cruciate ligament. The endo-button was used to build femur and the adsorbable screw to fix. The patients were followed up postoperative through anterior drawer test (ADT), Lachman test, pivot shift test, Lysholm score were used to evaluate the curative effects after the operation. 【Results】 All of them were followed up for 12 to 32 months with an average of 19 months. Anterior drawer test (ADT)was negative in all cases. Lachman test was negative in 46 cases，and positive in 2 cases. All cases in the pivot shift test(-), Lysholm knee function score was remarkably improved from 54.6 scores preoperative to 92.8 scores postoperative. The knee activity were recovered from 100 postoperative 10 weeks to over 120°. The healing of bone tunnels were satisfied byX-ray of postoperative. 【Conclusion】 ACL reconstruction with remnants and remaining bundle preservation is beneficial for the early improving tendon healing inside a bone tunnel. Arthroscopic reconstruction of ACL with the remaining bundle preserving technique could maintain stability of knee joint.