ShermanⅡ型急性前交叉韧带股骨侧断裂缝合联合内增强修复

Suture combined with internal augmentation for Sherman type Ⅱ acute anterior cruciate ligament femoral side rupture

摘要:

[目的] 介绍缝合联合内增强修复Sherman Ⅱ型急性前交叉韧带（anterior cruciate ligament, ACL）股骨侧断裂的手术技术和初步临床结果。[方法] 2024年1月—2025年6月对5例急性ACL股骨侧断裂采用上述镜下修复治疗。于股骨侧止点周围微骨折，在ACL股骨侧足印区稍前下拧入1枚4.5 mm锚钉，用2根强生缝线对ACL残端进行编织缝合，膝关节屈曲90°位应用1枚4.8 mm锚钉于ACL股骨止点处拧入，收紧缝线，将ACL残端复位固定回股骨侧止点。建立胫骨隧道，将4.8 mm锚钉尾线自胫骨隧道引出，拉紧打结固定，形成增强稳定结构。[结果] 术后伤口均I期愈合，末次随访时，患者Lachman试验Ⅰ度阳性、前抽屉试验阴性1例，其余患者两项试验均阴性。膝关节Lysholm评分由术前50.7分恢复至末次随访时92.6分；IKDC评分由术前47.3分恢复至末次随访时89.7分。患者总体满意度100%。[结论] 关节镜下前交叉韧带股骨侧止点缝合联合内增强技术可为肌腱质量尚可的Sherman Ⅱ型ACL断裂损伤患者提供更优治疗选择。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical results of suture combined with internal reinforcement repair for Sherman Ⅱ type acute anterior cruciate ligament (ACL) femoral side rupture. [Methods] From January 2024 to June 2025, 5 patients received above-mentioned arthroscopic repair of acute ACL femoral side rupture. Microfractures were made around the femoral insertion point, and one 4.5 mm anchor was slightly anteriorly and downwardly inserted into the ACL femoral insertion area. The two Johnson sutures were used to suture the residual ACL, and then one 4.75 mm anchor was inserted into the ACL femoral insertion point at a 90° flexion position of the knee joint. The sutures were tightened to restore and fix the residual ACL to the femoral insertion. After a tibial tunnel was established, and the tail sutures of the 4.75 mm anchor were drawn out from the tibial tunnel, tightened and tied to form an enhanced stable structure. [Results] All patients had wounds healed in the first stage after surgery. At the last follow-up, all patients had negative Lachman test and a negative anterior drawer test, except a patient who had a grade Ⅰ positive Lachman test and a negative anterior drawer test. The Lysholm score was improved from 50.7 before surgery to 92.6 at the last follow-up, while the IKDC score improved from 47.3 before surgery to 89.7 at the latest follow-up. The overall patient satisfaction rate reached 100%. [Conclusion] Arthroscopic ACL suture combined with internal augmentation provides a superior treatment option for the Sherman type Ⅱ rupture with acceptable tendon quality.