CAJ | 학술논문

目的探讨在关节镜下应用人工LARS韧带重建膝关节后交叉韧带(PCL)的手术技巧及临床疗效. 方法选择2006年6月- 2010年8月关节镜下采用LARS人工韧带重建PCL断裂患者14例,其中男10例,女4例；年龄19 ～58岁,平均38岁.致伤原因:运动扭伤9例,交通伤3例,摔伤2例.左侧5例,右侧9例.病程10 d ～1个月,平均15.7d.MRI示:PCL完全撕裂直接征象14例,前交叉韧带(ACL)完全撕裂直接征象2例,合并内侧半月板损伤5例,合并外侧半月板损伤3例,合并髋臼后壁骨折1例.Lysholn膝关节功能评分20～55分[(40 ±7.9)分].按照国际膝关节文件编制委员会( IKDC)评分:C级3例,D级11例.PCL在股骨及胫骨止点、隧道均用定位器完成. 结果本组所有患者伤口均为Ⅰ/甲愈合,术后无慢性滑膜炎、韧带断裂、韧带松动、活动明显受限等并发症.所有患者均获随访6 ～ 60个月,平均20.5个月.Lysholm膝关节功能评分84 ～93分[(88±3.6)分],与术前比较差异有统计学意义(P＜0.05).术后12个月根据IKDC评分标准分级:A级10例,B级4例. 结论在关节镜下运用LARS人工韧带重建膝PCL有效恢复了膝关节稳定性,避免了采用自体肌腱重建取材的并发症,也避免了同种异体肌腱移植材料的排斥及传染疾病的并发症.其手术操作简便,创伤小,康复快.
목적 탐토재관절경하응용인공LARS인대중건슬관절후교차인대(PCL)적수술기교급림상료효. 방법 선택2006년6월- 2010년8월관절경하채용LARS인공인대중건PCL단렬환자14례,기중남10례,녀4례；년령19 ～58세,평균38세.치상원인:운동뉴상9례,교통상3례,솔상2례.좌측5례,우측9례.병정10 d ～1개월,평균15.7d.MRI시:PCL완전시렬직접정상14례,전교차인대(ACL)완전시렬직접정상2례,합병내측반월판손상5례,합병외측반월판손상3례,합병관구후벽골절1례.Lysholn슬관절공능평분20～55분[(40 ±7.9)분].안조국제슬관절문건편제위원회( IKDC)평분:C급3례,D급11례.PCL재고골급경골지점、수도균용정위기완성. 결과 본조소유환자상구균위Ⅰ/갑유합,술후무만성활막염、인대단렬、인대송동、활동명현수한등병발증.소유환자균획수방6 ～ 60개월,평균20.5개월.Lysholm슬관절공능평분84 ～93분[(88±3.6)분],여술전비교차이유통계학의의(P＜0.05).술후12개월근거IKDC평분표준분급:A급10례,B급4례. 결론 재관절경하운용LARS인공인대중건슬PCL유효회복료슬관절은정성,피면료채용자체기건중건취재적병발증,야피면료동충이체기건이식재료적배척급전염질병적병발증.기수술조작간편,창상소,강복쾌.
Objective To study the operative techniques and clinical effect of arthroscopic reconstruction for posterior cruciate ligament (PCL) with ligament advanced reinforcement system (LARS)Y-shape double bundles artificial ligament. Methods From June 2006 to August 2010,14 patients (10 males and 4 females,at age range of 19-58 years,mean 38 years) with PCL ruptures were treated with LARS under arthroscopic observation.The injury causes included sports contusion in nine patients,traffic accidents in three and falling from height in two.Five patients were with left knee injury and three with right knee injury.The course of injury was 10-30 days (average 15.7 days).MRI indicated complete PCL ruptures in 14 patients and complete anterior cruciate ligament (ACL) ruptures in two.The combined injuries included medial meniscus injury in five patients,lateral meniscus injury in three and posterior acetabular wall fracture in one.The preoperative Lysholn score was (40 ± 7.9 ) points ( range,20-55 points).According to the international knee documentation committee (IKDC) grading,three patients were rated as grade C and 11 as grade D preoperatively.The operation was performed under arthroscopic observation.The ending point and tunnel of PCL of the femur and tibia were drilled with the help of a locator. Results All the patients obtained primary healing,with no complications such as infection,spontaneous rupture or laxity of graft postoperatively.The regular follow-up for all cases ranged from6-60 months ( average 20.5 months).The postoperative Lysholn score was ( 88 ± 3.6 ) points ( 84-93 points),with statistical difference in comparison with the preoperative score (P ＜ 0.05 ) The IKDCgrading was A in 10 patients and B in four 12 months postoperatively. Conclusions Arthroscopic reconstruction with LARS artificial ligaments can effectively recover the stability of the knees,avoid the complications brought by autologous tendon and prevent the allograft rejection complications induced by allogenic tendon graft.The treatment is characterized by simple procedures,minor wound and fast recovery.