摘要
目的关节镜下以可吸收界面螺钉固定骨-髌腱-骨(bone-patellartendon-bone,BPB)重建膝前十字韧带(ACL),并分析影响疗效的因素。方法1999年12月～2003年6月,采用关节镜下可吸收界面螺钉固定BPB移植修复ACL损伤32例,男22例,女10例;年龄20～45岁,平均32.5岁;左膝18例,右膝14例。急性损伤8例,陈旧性损伤24例。术前膝关节功能Lysholm评分平均为(52.1±5.6)分。行膝前小切口切取BPB并修整,建立骨隧道,安放胫骨侧骨块时外旋90°以适应ACL前内和后外两束的解剖结构和生理功能,采用可吸收界面螺钉固定BPB两端骨块。同时,在关节镜下处理合并损伤。术后早期行CPM功能锻炼。结果32例患者均获随访,随访6～40个月,平均32个月。采用改良Lysholm评分标准评价疗效:优24例,良7例,可1例;术后膝关节功能Lysholm评分为(98.7±3.6)分,与术前相比差异有显著性(P<0.05)。结论关节镜下可吸收界面螺钉固定BPB移植重建ACL是一种微创手术,操作简单,疗效肯定。
Objective To evaluate the clinical results of the anterior cruciate ligament (ACL) reconstruction by bone-patellar tendon-bone(BPB) transplantation and fixation with absorbable interface screws under arthroscopy. Methods From December 1999 to June 2003, 32 patients with ACL injuries underwent BPB transplantation. There were 22 males and 10 females, and the average age was 32.5 years (ranged from 20-45 years). The lesions were left knees in 18 and right knees in 14, including 8 acute and 24 chronic injuries. The BPB for reconstructing the ACL was harvested from the anterior approach mini-invasively; the implants were fixed with the absorbable interface screws under arthroscopy. The associated injuries were treated simultaneously. All the patients were encouraged to rehabilitate with the continuous passive motion (CPM) and other physical therapies earlier after operation. Results All the patients were available at follow-up; the average duration of follow-up was 32 months (ranged from 6-40 months). Before operation, anterior drawer test positive in 32, Lachman test positive in 20 and pivot shift test positive in 16, were changed into negative. The patients were evaluated according to Lysholm knee scoring scale and the modified Lysholm knee score, the functional results of knee joint were classified as excellent in 24, good in 7 and fair in 1, and the average knee score was 52.1±5.6 and 98.7±3.6 before and after operation respectively, the difference was of statistical significance(P< 0.05). There was no patellar fracture and loosing of the screws. However, 5 cases suffered from patellar anterior pain, while cured with conservative therapy. Conclusion The ACL reconstruction with BPB transplantation and absorbable interface screws fixation under arthroscopy is an easily feasible and mini-invasive operation, its clinical outcome is reliable.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2004年第3期137-140,共4页
Chinese Journal of Orthopaedics
