CAJ | 학술논문

目的评估关节镜下保留残迹的膝后交叉韧带(PCL)单束重建的技术和效果.方法自2004年4月至2006年6月,38例(38膝)患者经临床和关节镜检查证实为PCL功能不全,其中9膝伴后外侧角损伤,6膝伴后内侧角损伤,8膝伴外侧半月板破裂,4膝伴内侧半月板损伤.均于关节镜下行保留残迹和滑膜的PCL单束重建术,采用生物可吸收挤压螺钉解剖位复合固定莺建韧带.结果本组术后早期均未发生严重并发症.术后随访12-37个月[(20.79±7.92)个月],Lysholm膝关节功能评分由术前40～70分[(51.32±9.84)分],提高至随访时70-100分[(92.37±6.95)分](t=-30.14,P<0.01).国际膝关节文件编制委员会(IKDC)标准由术前异常(C级)16例、显著异常(D级)22例,改进为随访时正常(A级)18例、接近正常(B级)18例、异常(C级)2例(Z=-6.00,P<0.01).38例患者中,36例恢复伤前运动水平,2例运动水平较伤前减低.结论关节镜下保留残迹的PCL单束重建技术可行,治疗效果满意.保留PCL残迹与滑膜可能有利于重建韧带植入物牛物愈合和神经再支配.
목적 평고관절경하보류잔적적슬후교차인대(PCL)단속중건적기술화효과.방법 자2004년4월지2006년6월,38례(38슬)환자경림상화관절경검사증실위PCL공능불전,기중9슬반후외측각손상,6슬반후내측각손상,8슬반외측반월판파렬,4슬반내측반월판손상.균우관절경하행보류잔적화활막적PCL단속중건술,채용생물가흡수제압라정해부위복합고정앵건인대.결과 본조술후조기균미발생엄중병발증.술후수방12-37개월[(20.79±7.92)개월],Lysholm슬관절공능평분유술전40～70분[(51.32±9.84)분],제고지수방시70-100분[(92.37±6.95)분](t=-30.14,P<0.01).국제슬관절문건편제위원회(IKDC)표준유술전이상(C급)16례、현저이상(D급)22례,개진위수방시정상(A급)18례、접근정상(B급)18례、이상(C급)2례(Z=-6.00,P<0.01).38례환자중,36례회복상전운동수평,2례운동수평교상전감저.결론 관절경하보류잔적적PCL단속중건기술가행,치료효과만의.보류PCL잔적여활막가능유리우중건인대식입물우물유합화신경재지배.
Objective To evaluate the skill and outcome of arthroscopic reconstruction of posterior cruciate ligament (PCL) with retention of PCL remnant. Methods From April 2004 to June 2006, 38 patients (38 knees) with PCL deficiency were verified by clinical and arthroscopic examinations. Of them, there were 9 knees combined with disruption of the posterolateral comer, 6 with rupture of the posteromedial corner, 8 with lateral meniscus tear and 4 with medial meniscus tear. With reservation of PCL remnant and synovium, all the impaired PCLs were reconstructed with single bundle of autogenous quadrupled hamstring tendons under arthroscopy. Interference screws were used for direct anatomic fixation of the reconstructed ligament. Results No severe comphcations occurred at early stage after operation in all 38 patients who were followed up for 12-37 months (average 20.79 months). Lysholm score was improved significandy from 40-70 points (mean 51.32 pints) before operation to 70-100 pints (mean 92.37 points) at the latest follow up (t=-30.14, P<0.01). According to International Knee Documentation Committee (IKDC) score, there was a remarkable improvement from 16 abnormal knees (grade C) and 22 severely abnormal knees (grade D) preoperatively to 18 normal knees ( grade A), 18 nearly normal knees (grade B) and 2 abnormal knees at the latest follow up (Z=-6.00, P <0.01). Of 38 patients, 36 returned to normal sports level but 2 degraded level of sports. Conclusions Arthroscopic PCL reconstruction with retention of PCL remnants is a feasible technique, with satisfactory outcome. Preservation of PCL remnants and synovium may be beneficial to biological incorporation and reinnervation of the reconstructed ligament.