异体胫前肌腱'Y'形双束双隧道重建后十字韧带的疗效分析

摘要

Objective To investigate the clinical results of posterior cruciate ligament (PCL) reconstruction by double bundle-double tunnel Y-shape of the anterior tibialis tendon allograft. Methods From March 2001 to January 2008, 47 patients underwent PCL reconstruction were included. The allogeneic adult anterior tibialis tendon was prepared into the Y-shape double bundles with the length of 130 mm; A bundle was defined as A-side; B-side was two short bundle (B1, B2 bundle). A bundle was 70 mm in length with a diameter of 10-12 mm. B1 bundle (anterolateral bundle) was 55 mm long with a diameter of 6 mm; B2 bundle(posteromedial bundle) was about 50 mm with a diameter of 6 mm. The allograft ligament was installed through the antero-medial approach. Absorbable interface screws were fixed in the tibial tunnel firstly, and then in the femoral tundles. When being fixed, anterolateral bundle was in flexion of 90°, postero-medial bundle was in 30°. Assisted exercise with knee an angle-locked walking aid had continued for 8-10 weeks. Results The average operating time were 45 min. The average follow-up time was 49.5 months. Preoperative Lachmann was positive in all cases while Lachmann was negative in 39 cases, weakly positive in 5 cases, and positive in 4 cases postoperatively. Post-operative KT-1000 testing, Lysholm score and Tegner activity levels has improved significantly compare with the pre-operative ones. Conclusion The double folded bundles of adult anterior tibialis tendon has sufficient length and diameter for posterior cruciate ligament reconstruction with power tension. The methods of ligament passing through the tunnel has improved to ease the procedure.%目的 探讨异体胫前肌腱"Y"形双柬双隧道移植重建后十字韧带(posterior cruciate ligament,PCL)的临床效果.方法 2001年3月至2008年1月,采用将异体胫前肌腱编织成"Y"形双束韧带的方法治疗PCL损伤患者,其中47例具有完整随访资料,男39例,女8例;年龄18～43岁,平均24.3岁."Y"形双束韧带长度约为130mm,A端为长束(A束),长约70mm,直径为10～12mm;B端为两短束(B1、B2束),B1束(前外侧束)长为55mm,直径6mm,B2束(后内侧束)长约50mm,直径6mm.韧带安装时两端均从膝前内侧工作通道的切口进入,即:外(膝前内侧工作通道)→内(股骨、胫骨隧道内口)→外(股骨、胫骨隧道外口).可吸收界面钉先固定胫骨隧道侧,然后再固定股骨侧;固定前外侧束时屈膝90°,固定后内侧束时屈膝30°.术后予膝关节角度锁定助行器辅助锻炼8～10周.结果 手术时间30～60 min,平均(45±15)min.随访时间9～82个月,平均49.5个月.Lachmann后向试验术前均阳性,术后38例阴性、5例弱阳性、4例阳性;KT-1000试验术前(9.0±4.0)mm,术后(3.0±1.5)mm,两者比较差异有统计学意义(t=3.12,P=0.003).Lysholm评分术前(51.4±5.2)分,术后(93.3±4.1)分,两者比较差异有统计学意义(t=2.93,P=0.005).Tegner活动水平术后(6.9±1.3)分较术前(3.5±0.7)分有显著改善(t=2.99,P=0.004).结论 成人异体胫前肌腱对折编织成双束有足够的长度和直径重建PCL,其抗拉力强;改进后的韧带通过隧道时顺畅,简单易操作,省时.