CAJ | 학술논문

目的探讨前交叉韧带(ACL)损伤后,关节镜下保留并牵张ACL胫骨残端重建ACL的手术意义.方法对36例急性ACL损伤者应用自体半腱肌肌腱和股薄肌肌腱,关节镜下单束重建,保留胫骨残端,并采用牵张缝合的方法保持其张力,切除股骨残端并行髁间窝成形以避免髁间窝撞击综合症的发生.术后随访至少1年,按照IKDC和Lysholm膝关节评分标准评价疗效.结果所有患者均获得随访,随访时间12~16(12.1±1.2)个月,末次随访,35例患者Lachman试验(-),1例患者1度阳性,所有患者轴移试验均(-),活动度检查34例伸屈活动度均正常,1例5°屈膝欠缺,1例5°过伸膝欠缺,Lysholm评分:术前42~61(53.01±5.43)分,末次随访91.0~97.7(92.09±3.27)分,提高(39.08±2.16)分,术前术后比较均有统计学意义(P<0.05). IKDC膝关节主观评分为(94.6±3.7)分.未出现髁间窝撞击和独眼畸形等并发症.结论关节镜下保留胫骨残端重建ACL,有利于移植肌腱的准确定位及移植肌腱的再血管化和本体感觉的早期建立,并且封闭了胫骨隧道的内口,避免了关节液对隧道和移植肌腱潜在腔隙的冲刷,有助于腱骨的愈合.
목적 탐토전교차인대(ACL)손상후,관절경하보류병견장ACL경골잔단중건ACL적수술의의.방법 대36례급성ACL손상자응용자체반건기기건화고박기기건,관절경하단속중건,보류경골잔단,병채용견장봉합적방법보지기장력,절제고골잔단병행과간와성형이피면과간와당격종합증적발생.술후수방지소1년,안조IKDC화Lysholm슬관절평분표준평개료효.결과 소유환자균획득수방,수방시간12~16(12.1±1.2)개월,말차수방,35례환자Lachman시험(-),1례환자1도양성,소유환자축이시험균(-),활동도검사34례신굴활동도균정상,1례5°굴슬흠결,1례5°과신슬흠결,Lysholm평분:술전42~61(53.01±5.43)분,말차수방91.0~97.7(92.09±3.27)분,제고(39.08±2.16)분,술전술후비교균유통계학의의(P<0.05). IKDC슬관절주관평분위(94.6±3.7)분.미출현과간와당격화독안기형등병발증.결론 관절경하보류경골잔단중건ACL,유리우이식기건적준학정위급이식기건적재혈관화화본체감각적조기건립,병차봉폐료경골수도적내구,피면료관절액대수도화이식기건잠재강극적충쇄,유조우건골적유합.
@@@@ Objective To investigate the effect of arthroscopic anterior cruciate ligament reconstruction with tibial remnants pres -ervation and tesion.Methods Thirty-six cases of acute arthroscopic anterior cruciate injury were treated with autologous semitendinosus ten -don and gracilis tendon single-boudle anterior cruciate ligament reconstruction under arthroscopy .Anterior cruciate ligament tibial-sided rem-nant were all reserved and pulled to get tensioned by sutures .The femoral-sided remnant was removed and performed intercondylar fossa ex-pansive arthroplasty to avoid the happening of femoral intercondylar notch impingement syndrome .The patients were followed up for more than one year and evaluated according to IKDC and Lysholm rating scale .Results All the patients were followed up for (12.1 ±1.2)months. Thirty-five patients had negative Lachman test ,one patient had one degree of positive .All patients showed negative pivot shift test .34 patients showed normal range of motion;one patient had 5°flexion deficit and one had 5°hyperextension loss.Lysholm score:Preoperative (53.01 ± 5.43)points,the end of second follow-up of (92.09 ±3.27)points,raising(39.08 ±2.16)points(P<0.05).The IKDC subjective score was 94.6 ±3.7.No case occurred cyclops or impingement .Conclusion Arthroscopic renconstruction of ACL with the remnant preserving tech-nique can faciliate revascularization and reinnervation of the reconstructed ligament and benefit to position the tendon graft .ACL stump can close the tunnel to avoid the synoval fluid of the tunnel and the tendon graft erosion potential lacuna and benefit to the tendon -bone healing.