关节镜下膝前交叉韧带与后交叉韧带联合重建
前交叉韧带,,膝关节；,前交叉韧带；,后交叉韧带；,关节镜；,四股腘绳肌腱；,单束重建,1临床资料与方法,2结果,3讨论,参考文献：
摘 要：[目的]探讨膝关节双交叉韧带损伤的临床特点，评估关节镜下前交叉韧带(ACL)与后交叉韧带(PCL)联合重建的技术和效果。[方法]自2001年9月~2005年2月，13例病人(13膝)经关节镜检查证实ACL和PCL均断裂，其中5膝伴后内侧角(PMC)、内侧副韧带损伤(MCL)，4膝伴后外侧角损伤(PLC)，2膝伴外侧半月板破裂，1膝伴内侧半月板损伤，3膝伴腘动脉损伤，2膝伴腓总神经损伤。7例病人于损伤后急性期入院，2膝于急性期行腘血管探查修复，4膝行膝后内侧角、内侧副韧带修复。13例病人于伤后4~12周在关节镜下行自体移植物单束ACL和PCL联合重建术，其中4例同期后1/2 股二头肌腱重建后PLC，1例同期阔筋膜PMC、MCL重建。[结果]本组术后早期均未发生严重并发症。术后随访10~39个月，平均(2185±928)个月，Lysholm膝关节功能评分为75~95分，平均(8654±689)分。国际膝关节文件编制委员会(IKDC)综合评定由术前显著异常(D级)13例，改进为随访时正常(A级)3例、接近正常(B级)8例、异常(C级)2例。13例病人中，11例恢复至伤前运动水平，2例运动水平较伤前减低。 [结论]膝关节双交叉韧带损伤多伴有其它重要结构损伤，需妥善处理合并损伤。关节镜下自体移植物联合单束重建ACL和PCL创伤小、手术操作精细，术后膝关节功能恢复满意。关键词：膝关节； 前交叉韧带； 后交叉韧带； 关节镜； 四股腘绳肌腱； 单束重建
Arthroscopic combined reconstruction of anterior and posterior cruciate ligament ∥ SUN Lei, NING Zhijie, TIAN Min, et al. Orthopaedic Center of PLA, The 88th Hospital of PLA, Tai'an 271000
Abstract：[Objective]To explore the clinical characteristics of bicruciate ligament injury of the knee, evaluate the technique and outcome of arthroscopic combined reconstruction of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) with autografts.[Method]From Sept 2001 to Feb 2005, 13 knees with combined ACL and PCL tear in 13 patients were verified with arthroscopy. Of them, 5 knee were combined with rupture of the posteromedial coner (PMC) and medial collateral ligament (MCL), 3 combined with disruption of the posterolateral corner (PLC), 2 with lateral meniscus tear, 1 with medial meniscus tear, 3 associated with popliteal vascular injury and 2 with peroneal nerve injury. Seven patients were admitted into this department in acute phase of trauma, repair of popliteal artery in 2 patients and repair of PMC and MCL in 4 patients were performed in this phase. Arthroscopic combined reconstruction of ACL and PCL with autografts was performed in all patients from 4 to 12 weeks after trauma, reconstruction of PLC with the posterior half of biceps femoris tendon tenodesis in 3 patients and reconstruction of PMC and MCL with femoral fascia in 1 patient were completed simultaneously.[Result]No severe complications occurred in early stage after operation in the 13 patients. All of them were followed up from 10 to 39 months with an average of 86.54±6.89 months. Lysholm score was 70~95 with an average of 86.54±6.89. Furthermore, there was a significant improvement in IKDC score from severely abnormal ( grade D ) in 13 knee preoperatively to normal ( grade A) in 3 knees, nearly normal ( grade B ) in 8 knees and abnormal in 2 knees at follow up. Of the 13 patients, 11 patients returned to the same sports level before injury and 3 were under the level.[Conclusion]Bicruciate ligament tear of the knee is usually combined with other important structure damages, and careful assessment and treatment of the combined injuries are essential. Arthroscopic combined reconstruction of ACL and PCL with autografts has the advantage of minimal trauma in surgery and reliable satisfactory outcome. ......
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