目的 探究关节镜下应用自体腓骨长肌腱和半腱肌腱重建后交叉韧带（posterior cruciate ligament，PCL）手术的临床疗效及预后。 方法 选取本院后交叉韧带断裂患者33例，予以关节镜下取自体腓骨长肌腱和半腱肌腱重建PCL治疗。比较术前、术后3、6、12个月患者IKDC评分、Lysholm评分、Tegner评分和胫骨后移距离，对患者膝关节的综合功能进行评估。 结果 患者术后12个月X线片和MRI显示螺钉位置固定可靠，无断裂、松脱及骨道愈合，后抽屉实验转阴性。术后12个月胫骨后移距离较术前明显缩短，（11.33±1.45）cm VS（3.27±0.80）cm，P<0.05；术后3、6、12个月胫骨后移距离有缓慢增长趋势，分别为（2.94±0.90）、（3.18±0.84）及（3.27±0.80）cm，无统计学差异。与术前（50.33±3.31）相比，术后3、6、12个月IKDC评分分别为（70.97±2.59）、（86.18±1.78）、（92.67±2.13），P<0.05；Lysholm评分术前（51.82±3.95），术后3、6、12个月分别为（73.52±2.59）、（87.12±1.93）、（93.94±1.98），P<0.05；Tegner评分术前（1.97±1.10），术后3、6、12个月分别为（5.21±0.74）、（7.67±0.85）、（8.52±0.57），P<0.05。功能明显改善，且评分比较均逐步提高，具有显著性差异。 结论 在镜下应用自体腓骨长肌腱和半腱肌腱重建后交叉韧带的临床疗效确切，并发症较少，可显著改善膝关节的功能、疼痛和稳定性，值得推荐。
Abstract
Objective To investigate the clinical effect and prognosis of reconstruction of posterior cruciate ligament (PCL) with peroneal longus tendon and semitendinosus tendon autografts under arthroscopy. Methods The clinical data of 33 patients who met the inclusion criteria and treated with PCL rupture in the Hospital of Traditional Chinese Medicine Affiliated to Southwest Medical University from June 2018 to May 2019 were retrospectively analyzed. Posterior cruciate ligament reconstruction with autologous peroneus longus tendon and tendon of semitendinosus under arthroscopy were performed. The IKDC score, Lysholm score, Tegner score and the backwards distance of tibial plateau were compared before operation, 3 months, 6 months and 12 months after operation to evaluate comprehensive function of the knee joint. Results The X-ray and MRI of the patient 12 months after operation showed that the screw position was securely fixed without rupture or release, union of bone canal, and the PDT turned negative. The backwards distance of tibial plateau 12 months after operation was obviously shorter than that before operation, (11.33±1.45) cm VS(3.27±0.80) cm, P<0.05. after operation of 3 months, 6 months, and 12 months, The backwards distance of tibial plateau increased slowly at 3, 6, 12 months postoperatively (2.94±0.90), (3.18±0.84) and (3.27±0.80) cm, respectively, without statistical difference. At 3, 6, and 12 months after operation, the IKDC scores were (70.97±2.59), (86.18±1.78), (92.67±2.13), respectively, compared with (50.33±3.31) before operation, P<0.05. Lysholm scores were (73.52±2.59), (87.12±1.93), (93.94±1.98), respectively, compared with (51.82±3.95) before operation, P<0.05. Tegner scores were (5.21±0.74), (7.67±0.85), (8.52±0.57), respectively, compared with (1.97±1.10) before operation, P<0.05 The function was improved significantly, the comparison between scores was gradually increased, with significant difference. Conclusions The clinical effect of posterior cruciate ligament reconstruction with autologous peroneus longus and semitendinosus tendon under arthroscopy is definite with fewer complications. Besides, the surgery can significantly improve knee joint function, pain and stability, which is worthy of recommendation.
关键词
关节镜； /
/
腓骨长肌腱； /
/
半腱肌腱； /
/
后交叉韧带重建
Key words
Arthroscopy; /
Autologous peroneus longus tendon; /
Semitendinosus tendon; /
Posterior cruciate ligament reconstruction
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基金
2018年泸州市人民政府-西南医科大学科技战略合作项目（2018LZXNYD-ZK43）；2019年西南医科大学附属中医医院科研项目（国家自然基金培养项目）（2019XYLH-001）；2020年国家自然科学基金课题（青年科学基金项目）（82004458）；深圳市医疗卫生“三名工程”高层次医学团队（SZSM201612019）
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