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目的探讨急性前交叉韧带(anterior cruciate ligament,ACL)断裂后镜下单束解剖重建术中股骨骨道实用定位方法及临床效果。方法对ACL断裂患者行关节镜下自体半腱股薄肌腱单束解剖重建术,术中股骨侧骨道采用足印中心定位法,同时术中寻找股骨外侧髁间嵴、分叉嵴等骨性标志对定位点准确性进行校对。术前、术后进行膝关节功能检查及评分,包括前抽屉试验、Lachman试验、pivot shift试验、Lysholm评分、Tegner评分、IKDC评分。结果 (1)镜下100%可见股骨外髁间嵴,但分叉嵴的出现率仅有42%(48/115)。(2)术后前抽屉试验阴性率79%(术后3个月)、77%(术后24月);Lachman试验阴性率80%(术后3个月)、71%(术后24月)、pivot shift试验阴性率97%(术后3个月)、95%(术后24月)。(3)Lysholm评分、Tegner评分及IKDC评分与术前比较差异有统计学意义(P<0.01)。结论 ACL单束解剖重建股骨足印区中心点法能提供足够膝关节稳定性,取得满意临床效果,但对股骨止点残留韧带依赖性高;股骨外侧髁间嵴镜下易于辨认,但分叉嵴辨别率低。
Objective To investigate the practical method and clinical effect of femoral and femoral osteotomy in acute single anterior cruciate ligament (ACL) fracture under microscope. Methods Arthroscopic anatomical reconstruction of semitendinosus tendon with arthroscopy was performed in patients with ACL rupture. The center of the femoral side was treated with footprinting. The mean femoral intercondylar and bony ridges The mark verifies the accuracy of the anchor point. Preoperative and postoperative knee function tests and scores, including the drawer test, Lachman test, pivot shift test, Lysholm score, Tegner score, IKDC score. Results (1) 100% of microscopic appearance of femoral intercondylar eminence, but the occurrence of bifurcation ridge only 42% (48/115). (2) The negative rate of post-operation drawer test was 79% (3 months postoperatively) and 77% (postoperative 24 months). The negative rate of Lachman test was 80% (3 months postoperatively) and 71% (24 months postoperatively ), The negative rate of pivot shift test was 97% (3 months after surgery) and 95% (after 24 months). (3) Lysholm score, Tegner score and IKDC score were significantly different from those before operation (P <0.01). CONCLUSION: The single-point ACL anatomical reconstruction of femoral footprints area can provide sufficient stability of the knee joint and achieve satisfactory clinical results, but it is highly dependent on residual ligaments at the femoral node. The lateral femoral condyle is easy to identify, but the bifurcation Cristae resolution is low.