引用
关节镜下经后侧入路重建后交叉韧带
【摘要】 目的:关节镜下经后内侧后外侧和后纵隔入路保留板股韧带和残留的后交叉韧带(PCL)纤维重建PCL,探讨此技术的临床应用效果。方法:对9例PCL损伤患者在关节镜下结合常规关节镜入路和后内侧后外侧入路及后纵隔入路保留板股韧带和残留的PCL纤维应用自体腘绳肌腱重建PCL。在后外侧入路的关节镜监视下,胫骨隧道定位在PCL胫骨止点外侧关节面下方1~1.5cm。股骨隧道经前外侧入路定位于股骨内侧髁关节软骨后方1cm。自体肌腱移植物利用钢丝引导通过骨隧道,移植物两端用可吸收界面螺钉固定。术后6个月了解膝关节功能恢复情况。结果:9例患者均获随访,时间7~14个月,平均8.6个月。术后6个月,患者均无伸膝受限;2例有10°~15°屈膝受限;1例有Ⅰ度后抽屉试验阳性。Lysholm膝关节功能评分术前(47.6±14.9),术后6个月(92.9±4.6)(P<0.01)。结论:膝关节后内外侧入路和后纵隔入路重建PCL的方法,镜下视野清楚、无盲区,操作安全,韧带的胫骨止点定位准确,短期疗效肯定。【关键词】 膝关节;关节镜检查;后交叉韧带;重建手术方式Arthroscopic posterior cruciate ligament reconstruction using the posterior portalZHAO Jia-yi, ZHENG Jie, Li Xie-hai, He Shi-hui, HE Yu-qingDepartment of Orthopedic Surgery, ZhoushanHospital, Zhoushan 316000,China【Abstract】 Objective To introduce the arthroscopic posterior cruciate ligament (PCL) reconstruction using the posteromedial portal, the posterolateral portal and the posterior trans-septal portal with preservation of the remnant PCL fibers and intact meniscofemoral ligaments,and to evaluate the clinical results. Methods 9 cases of PCL injury were treated with the autogenous hamstring tendon arthroscopically through the routine portal, the posteromedial portal, the posterolateral portal and the posterior trans-septal portal with preservation of the remnant PCL fibers and intact meniscofemoral ligaments.The tibial drill guide was introduced through the anteromedial portal and positioned on the fossa for the PCL on the tibial, 1 to 1.5cm below the articular surface and just lateral to the midline, under arthroscopic guidance from the posterolateral portal. The femoral tunnel was made 1 cm posterior to the articular cartilage of the medial femoral condyle by use the guide pin introduced through the anterolateral portal. The tendon graft was positioned in the knee joint by use of the tibial and femoral double-folded silk loops that traversed the bony tunnels. The graft was fixed by use of bioabsorbable Intrafix screw systems at both the ends. The total knee function was evaluated with Lysholm scale after six months postoperatively. Results All case were followed up for an average 8.6 months (range,7 to 14 months), Six months postoperatively knee extension restored to normal in all cases;10°to 15°flexion limitation was found in 2 cases; one case with Ⅰdegree of positive posterior drawer test was found. The Lysholm knee score were 47.6±14.9 before operation and 92.9±4.6 after 6 months postoperatively. There was significant difference between preoperation and postoperatively (P<0.01). Conclusions The method of arthroscopic PCL reconstruction using the posteromedial portal, the posterolateral portal and the posterior trans-septal portal with preservation of the remnant PCL fibers and intact meniscofemoral ligaments provides adequate exposure of the posterior knee compartment ,safe and accurate placement of the tbial tunnel; The short-term results of the technique are encouraging.