摘要
目的探讨关节镜下应用可吸收RIGIDfix交叉钉与Intrafix膨胀挤压螺钉固定自体或异体肌腱,重建膝关节后交叉韧带(posterior cruciate ligament,PCL)的近期临床效果。方法2005年6月-2007年1月,收治膝关节PCL损伤患者36例,其中男21例,女15例;年龄15～51岁,平均30.4岁。均为单侧损伤,左膝19例,右膝17例。36例均有明确外伤史。单纯PCL损伤7例;合并内侧副韧带损伤13例,外侧副韧带损伤9例,后外侧结构损伤2例,内侧半月板损伤11例,外侧半月板损伤10例,神经血管损伤2例。在关节镜下,移植肌腱胫骨侧用可吸收RIGIDfix交叉钉固定,股骨侧用Intrafix膨胀挤压螺钉固定。术后随访,采用Lysholm关节评分、国际膝关节文献编制委员会(international knee documentation committee,IKDC)分级评估标准以及后Lachman试验进行疗效评定。结果36例获随访6～26个月,平均10.4个月。IKDC评分术前B级3例(8.4%),C级12例(33.3%),D级21例(58.3%);术后A级9例(25%),B级21例(58.3%),C级6例(16.7%);Lysholm评分从术前(42.52±5.24)分增加至术后(91.24±5.68)分;后Lach-man试验,术前(+)5例,(++)20例,(+++)11例,术后(+)2例,(-)34例;各指标手术前后比较差异均有统计学意义(P<0.05)。术后患者疼痛均消失,关节稳定,恢复关节活动度,固定物无松动;4例出现局部积液和滑膜炎,经保守治疗后好转。结论关节镜下应用RIGIDfix交叉钉与Intrafix膨胀挤压螺钉固定自体或异体肌腱重建膝关节PCL,方法简便,固定确实,并可早期行功能锻炼。
Objective To explore the short-term clinical effects on application of absorbable RIGIDfix cross pins and Intrafix screw for posterior cruciate ligament （PCL） reconstruction with autogenetic or xenogenic semitendinosus-plussemimembranosus tendons under arthroscope. Methods From June 2005 to January 2007, 36 cases of PCL injuries （including 20 fresh injuries and 16 old ones） were treated. There were 21 males and 15 females, aged 15-51 years old, mean 30.4 years. There were 19 cases in the left side and 17 cases in the right side. Thirteen cases out of them complicated with medial collateral ligament injury; 9 cases complicated with lateral collateral ligament injury; 2 cases complicated with posterolateral structure injury; 11 cases complicated with medial meniscus injury; 10 cases complicated with lateral meniscus injury; 2 cases complicated with nerve and vascular injury. PCL reconstruction was accomplished by arthroscopy with autogenetic or xenogenic 4-strand semitendinosus-plus-semimembranosus tendons. RIGIDfix cross pins were used for tibial side fixation, and Intrafix was used for femoral side fixation. Lysholm scores, international knee documentation（IKDC） grading and Lachman experiment were used for evaluation before operation and in the follow up. Results All the cases had been followed up for 6 to 26 months （average 10.4 months）. IKDC grading showed that 3 patients （8.4 %） were graded as B, 12 patients （33.3%） as C, 21 patients （58.3%） as D before operation, while 9 patients （25 %） were graded as A, 21 patients （58.3%） as B, 6 patients （16.7%） as C after operation. Lysholm scores raised from 42.52 ±5.24 before operation to 91.24± 5.68 after operation. Lachman experiment results showed that there were 5 cases （＋）, 20 cases （＋＋） and 11 cases（＋＋＋） before operation, while there were 2 cases （＋） and 34 cases （-） after operation. Each index was significant between before and after surgery （P 〈 0.05）. After surgery, all the cases got good pain relief. Joint was stable, and motion range recovered. No pin and screw loosening was found. Only 4 cases suffered from effusion and synovitis after surgery, and they were recovered after conservative treatment. Conclusion The method of using RIGIDfix-Intrafix complexes under arthroscopy for PCL reconstruction is simple and the fixation is rigid. Early functional exercise after operation is possible.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2008年第2期234-238,共5页
Chinese Journal of Reparative and Reconstructive Surgery
基金
辽宁省教育厅科研基金资助项目(05L469)~~
