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  • Title: [Short-term effectiveness of arthroscopic single bundle four-strand reconstruction using autologous semitendinosus tendon and anterior half of peroneus longus tendon for posterior cruciate ligament injuries].
    Author: Wang X, Han X, Shi X, Yuan Y, Tan H.
    Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2021 May 15; 35(5):556-561. PubMed ID: 33998207.
    Abstract:
    OBJECTIVE: To investigate the short-term effectiveness of arthroscopic single bundle four-strand reconstruction using autologous semitendinosus tendon and anterior half of peroneus longus tendon for posterior cruciate ligament (PCL) injuries. METHODS: A clinical data of 30 patients with PCL injury, who were admitted between December 2015 and September 2018 and met the selection criteria, was retrospectively analyzed. All patients were treated with arthroscopic single bundle four-strand reconstruction using autologous semitendinosus tendon and anterior half of peroneus longus tendon and TightRope technique. Among them, 19 were male and 11 were female, aged 17-48 years (mean, 28.2 years). The PCL injury was caused by traffic accident in 8 cases, sport in 14 cases, falling and bruising by a heavy objective in 5 cases, and other injuries in 3 cases. The interval between injury and operation was 10-90 days (mean, 39.3 days). The PCL injury was rated as grade Ⅱ in 6 cases and grade Ⅲ in 24 cases. The posterior drawer test was positive in 26 cases and the inverse Lachman test was positive in 24 cases. The International Knee Documentation Committee (IKDC) score was 61.37±8.49, and the objective IKDC ligament grading was near normal in 2 cases, abnormal in 8 cases, and significantly abnormal in 20 cases. The modified Lysholm knee score was 62.20±5.67. The knee range of motion (ROM) was (101.83±8.15) °. RESULTS: The operative time ranged from 70 to 110 minutes (mean, 79.7 minutes). All incisions healed by first intetion. All patients were followed up 12-24 months (mean, 19.0 months). There were 3 cases of deep vein thrombosis in the lower extremity after operation, and 1 case of approximately 10° limitation of knee extension. At last follow-up, the posterior drawer test was positive in 2 cases and the inverse Lachman test was positive in 1 case, with significant differences compared with the preoperative period ( χ 2=38.571, P=0.000; χ 2=36.274, P=0.000). The IKDC score was 84.67±3.67, and the objective IKDC ligament grading was normal in 16 cases, nearly normal in 10 cases, abnormal in 3 cases, and significantly abnormal in 1 case; the modified Lysholm knee score was 90.37±4.49; all of the above indexes were significantly better than preoperative ones, and the differences were significant ( t=-12.387, P=0.000; Z=-2.810, P=0.005; t=-22.865, P=0.000). Knee ROM was (88.33±9.86)° at 1 month after operation and reached (113.33±13.48)° at last follow-up, showing significant differences between pre- and post-operation ( P<0.05). MRI re-examination showed that the form and position of reconstructed PCL were satisfactory. CONCLUSION: It can obtain good short-term effectiveness for PCL injuries by arthroscopic single bundle four-strand reconstruction using autologous semitendinosus tendon and anterior half of peroneus longus tendon, which has the advantages of reliable surgical approach, safe operation, and precise effectiveness. 目的: 探讨应用自体半腱肌肌腱及腓骨长肌肌腱前侧半在关节镜下单束 4 股重建后交叉韧带（posterior cruciate ligament，PCL）的早期疗效。. 方法: 回顾分析 2015 年 12 月—2018 年 9 月收治且符合选择标准的 30 例膝关节 PCL 损伤患者临床资料，关节镜下使用 TightRope 技术以自体半腱肌肌腱及腓骨长肌肌腱前侧半单束 4 股重建 PCL。男 19 例，女 11 例；年龄 17～48 岁，平均 28.2 岁。致伤原因：交通事故伤 8 例，运动伤 14 例，摔伤及重物砸伤 5 例，其他伤 3 例。受伤至手术时间 10～90 d，平均 39.3 d。PCL 损伤分级：Ⅱ级 6 例，Ⅲ级 24 例。后抽屉试验阳性 26 例，反 Lachman 试验阳性 24 例。国际膝关节文献委员会（IKDC）评分（61.37±8.49）分，IKDC 韧带客观分级接近正常 2 例、异常 8 例、明显异常 20 例；改良 Lysholm 膝关节评分（62.20±5.67）分；膝关节活动度（range of motion，ROM）为（101.83±8.15）°。. 结果: 手术时间 70～110 min，平均 79.7 min。术后切口均Ⅰ期愈合。患者均获随访，随访时间 12～24 个月，平均 19.0 个月。术后出现下肢深静脉血栓形成 3 例，约 10° 膝关节伸直受限 1 例。末次随访时，后抽屉试验阳性 2 例，反 Lachman 试验阳性 1 例，与术前比较差异均有统计学意义（ χ 2=38.571， P=0.000； χ 2=36.274， P=0.000）。IKDC 评分为（84.67±3.67）分，IKDC 韧带客观分级正常 16 例、接近正常 10 例、异常 3 例、明显异常 1 例；改良 Lysholm 膝关节评分为（90.37±4.49）分；上述指标均明显优于术前，差异有统计学意义（ t=−12.387， P=0.000； Z=−2.810， P=0.005； t=−22.865， P=0.000）。术后 1 个月膝关节 ROM 为（88.33±9.86）°，末次随访时达（113.33±13.48）°，手术前后各时间点间比较差异均有统计学意义（ P<0.05）。MRI 复查示重建 PCL 形态及位置满意。. 结论: 采用自体半腱肌肌腱及腓骨长肌肌腱前侧半在关节镜下单束 4 股重建 PCL 早期疗效较好，具有手术方式可靠、操作安全、疗效确切等优点。.
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