中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (7): 1311-1314.doi: 10.3969/j.issn.1673-8225.2010.07.040

• 组织构建临床实践 clinical practice in tissue construction • 上一篇    下一篇

同种异体腱Tibial-inlay技术重建膝关节后交叉韧带31例

李志怀，李  宁，张义龙，刘建丰，宋有鑫，李  哲   

  1. 承德医学院附属医院骨科，河北省承德市  067000
  • 出版日期:2010-02-12 发布日期:2010-02-12
  • 通讯作者: 张义龙，硕士，主治医师，承德医学院附属医院骨科，河北省承德市 067000 zhangyilong267@126.com
  • 作者简介:李志怀，男，1964年生，河北省隆化县人，汉族，1988年河北医科大学毕业，副主任医师，主要从事骨关节损伤与疾患的研究。

Tibial-Inlay technique for reconstructing posterior cruciate ligament of knee joint with allograft tendons in 31 cases

Li Zhi-huai, Li Ning, Zhang Yi-long, Liu Jian-feng, Song You-xin, Li Zhe   

  1. Department of Orthopaedics, Affiliated Hospital of Chengde Medical College, Chengde   067000, Hebei Province, China
  • Online:2010-02-12 Published:2010-02-12
  • Contact: Zhang Yi-long, Master, Attending physician, Department of Orthopaedics, Affiliated Hospital of Chengde Medical College, Chengde 067000, Hebei Province, China zhangyilong267@126.com
  • About author:Li Zhi-huai, Associate chief physician, Department of Orthopaedics, Affiliated Hospital of Chengde Medical College, Chengde 067000, Hebei Province, China

PDF

641

被引次数

16

摘要：

背景：文献报道采用双束重建后交叉韧带是较好的选择，但Tibial-inlay技术与之并无明显差别。
目的：评估同种异体腱Tibial-inlay技术重建膝关节后交叉韧带的效果。
方法：选择2006-02/2008-05 承德医学院附属医院骨科收治的，经关节镜检查证实为后交叉韧带断裂患者31例，交通事故伤14例，重物砸伤9例，运动损伤8例，均于关节镜下行同种异体腱(带骨块)Tibial-inlay重建后交叉韧带。术中尽量多保留原后交叉韧带残迹，制备后交叉韧带股骨侧隧道。应用两端带骨块的异体膑腱或一端带骨块的异体跟腱，将侧骨块修整成宽1.0~1.5 cm，长2 cm的梯形块状，即移植骨块与骨槽间除靠摩擦力固定外，还可产生压应力，增加其稳定性。剥离后交叉韧带胫骨附丽点，在止点处依骨块大小制梯形骨槽，将异体腱骨块嵌入骨槽，然后将另一端通过牵引线经关节引入股骨隧道，前抽屉位拉紧后由外向内拧入挤压螺钉固定肌腱或骨块。术前、随访时均记录膝关节后抽屉试验不稳定程度、关节活动度、膝关节Lysholm功能评分。
结果与结论：术后早期患者均未发生严重血管神经损伤、排异反应、感染等并发症。31例患者均获得随访，随访12~24个月。术前全部病例后抽屉试验均> 2+，其中3+ 、4+ 占84%；术后后抽屉试验结果为：0(正常)4例，1+ 为17例，2+为9例，3+为1例，显示后移程度较术前明显改进(P < 0.05)；术后随访Lysholm膝关节功能评分较术前明显提高(P < 0.05)，关节活动度较术前明显提高(P < 0.05)。说明Tibial-inlay技术重建膝关节后交叉韧带创伤小，固定可靠，技术相对简捷，治疗效果满意。

关键词: 膝关节, 后交叉韧带, 关节镜, Tibial-inlay技术, 肌肉肌腱组织工程

Abstract:

BACKGROUND: Literatures report that double-bundle reconstruction is a better choice for posterior cruciate ligament (PCL), but Tibial-inlay technique exhibits no significant difference.
OBJECTIVE: To evaluate the effect of Tibial-inlay technique used in the PCL reconstruction with allograft tendons.
METHODS: Thirty-one patients with PCL rupture were verified by arthroscopy in the Department of Orthopaedics, at the Affiliated Hospital of Chengde Medical College between February 2006 and May 2008, including 14 knees caused by traffic accident injury, 9 knees by crashing, and 8 knees by athletic injury. All the damaged PCLs were reconstructed with allograft tendons by Tibial-inlay technique under arthroscopy. During surgery, the remnants of the original PCL were retained as much as possible, PCL femoral tunnel was prepared. By using of allogeneic patella tendon with bone block at both ends or achilles tendon allograft with bone block at one side, the lateral bone block was chipped into trapezoidal block at a width of 1.0-1.5 cm and a length of    2 cm, that is, in addition to relying on friction force to fix between bone groove and bone graft, it can also generate compressive stress and increase its stability. The PCL tibial attached point was stripped, the trapezoid bone groove was prepared according to the size of bone block at the insertion site, and allogeneic bone block was embedded into bone groove, then the other end was introduced to femoral tunnel using pulling wire through the joint, after tensed at anterior drawer site, the extrusion screw was twisted forward to fix the tendon or bone. Before operation and during follow-ups, the posterior drawer test knee instability, joint activity, Lysholm knee function scores were recorded. 
RESULTS AND CONCLUSION: No severe complications, such as vascular nerve injury, rejection or infection, occurred in early stage after operations in 31 patients. All of them were followed up for 12-24 months. Posterior drawer test of all the subjects were above 2+ before operation, of which, 3+ and 4+ were 84%; the posterior drawer test results were as the following after operation: 4 cases of 0+ (normal), 17 cases of 1+, 9 cases of 2+ and 1 case of 3+, which shows the improvement of retroposition (P < 0. 05); Lysholm score was remarkably improved at follow-up compared with preoperation (P < 0.05), and there were significant improvements in the joint range of motion (P < 0.05). The reconstruction of PCL by Tibial-inlay technique with allograft tendons has advantages of minimal trauma in surgery, reliable fixation and satisfactory outcome.

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