摘要
目的：探讨运用自体4股腘绳肌腱重建前交叉韧带（anterior cruciate ligament,ACL）时,磷酸三钙/聚乳酸（TCP/PLA）可吸收界面螺钉股骨隧道固定的有效方法,评价其临床疗效。方法：ACL损伤需行重建手术的患者27例,男18例,女9例;年龄21-48岁,平均34.5岁;左膝19例,右膝8例。所有患者均以4股自体腘绳肌腱为重建移植物,关节镜下以TCP/PLA可吸收界面螺钉固定股骨隧道,intrafix系统固定胫骨隧道重建ACL。术中注意股骨隧道周围的残端清理,过屈膝关节110°-120°,以使拧入可吸收界面螺钉与股骨隧道轴平行。达到坚强的内口固定。结果：27例中5例发生初次挤压失败。挤压螺钉螺母碎裂1例,隧道内脱空1例,脱空进入关节腔内3例。5例患者均进行挽救治疗后重新固定成功。27例患者均获得随访,随访时间10-18个月,平均14个月。Lachman试验：阴性14例;阳性Ⅰ度10例,阳性Ⅱ度3例。按Lysholm功能评分标准评估膝关节功能,术前平均为（53.1±3.9）分,终末随访时平均（93.3±3.1）分,差异有显著性统计学意义（P〈0.05）。结论：关节镜下TCP/PLA可吸收界面螺钉隧道内口固定、4股腘绳肌腱重建ACL能良好地恢复膝关节功能。掌握界面螺钉挤入股骨隧道内口的角度是移植物股骨隧道内固定的关键。
Objective：To study the effective technique and curative effect of TCP/PLA absorbable interference screw fixation in femoral tunnel during arthroscopic reconstruction of anterior cruciate ligament （ACL） with four-stranded autogeneic hamstring tendons. Methods：Twenty-seven patients （male 18 and female 9） who need operation with reconstruction of ACL were analyzed. The age was from 21 to 48 years with the mean of 34. 5 years,19 cases in left and 8 cases in right side. All the cases underwent arthroscopic reconstruction of ACL with four-stranded autogeneic hamstring tendons because of ACL injury. Grafs were fixed by TCP/PLA absorbable interference screw in femoral tunnel and by intrafix system in tibial tunnel. The residue of ACL was cleared carefully. The flexion of knee were 110°- 120° so that TCP/PLA absorbable interference screw were parallel to the axle of femoral tunnel and forcefully fixed graft. Results： Failed operation had 5 cases at the first time. Among the 5 cases, 1 female screw disrupted, 1 screw failed off in the tunnel and 3 cases failed off into articular cavity. All of these 5 cases were retighten successfully. Followed-up time was from 10 to 18 months （average：14 months） in 27 cases. The postoperative Lachman test revealed negative in 14 cases,masculine in 13 cases （degree Ⅰ was 10 cases and degree Ⅱ3 cases）. The mean Lysholm score was 53.1± 3.9 before operation and 93.3±3. 1 at the end of followed-up time. Significance difference was found between them （ P 〈 0. 05 ）. Conclusion ： Fixation of four-stranded autogeneic hamstring tendons by TCP/PLA absorbable interference screw in the inlet of femoral tunnel can restore function of knee joint. The key of this technique is mastering the angle of TCP/PLA absorbable interference screw in the inlet of femoral tunnel.
出处
《中国骨伤》
CAS
2007年第4期234-236,共3页
China Journal of Orthopaedics and Traumatology
关键词
前交叉韧带
胭绳肌腱
股骨隧道内口固定
可吸收界面螺钉
Anterior cruciate ligament
Hamstring tendon
Fixation in inlet of femoral tunnel
Absorbable interference screw
