急性前交叉韧带断裂镜下缝合和股骨双隧道悬吊固定△（开放获取）

Arthroscopic suture with doubletunnel suspension fixation of acute anterior cruciate ligament tear

摘要:

[目的]介绍急性前交叉韧带（anterior cruciate ligament, ACL）断裂镜下缝合和股骨双隧道悬吊固定的手术技术和初步结果。[方法]2022 年 1 月—2024 年 1 月采用上述技术治疗急性 ACL 损伤患者 12 例。麻醉成功后患者取仰卧位，常规关节镜检。编织缝合、捆扎 ACL 残端，于 ACL 股骨前内侧束和后外侧束解剖起点向股骨外髁作双骨隧道，将缝线分别穿过双骨道，拉至股骨外髁皮质外，穿过悬吊钛板线孔。并于线袢处引入缝线，将缝线从前内侧骨道引入关节腔内，一端穿过残端。屈膝 30°后抽屉试验应力位，收紧经过悬吊钛板的缝线，拉紧引入关节腔内缝线，打结固定。[结果] 12 例患者手术均顺利完成。患者均获 10~24 个月随访，与术前相比，末次随访时，Lysholm 膝关节功能评分 [(49.7±6.7), (93.5±2.9), P＜0.001]、 IKDC 评分 [(50.8±5.2), (89.1±3.3), P＜0.001]、Tegner 膝关节活动水平量表评分 [(1.0±0.7), (5.3±1.1), P＜0.001] 均显著改善。MRI 显示 12 例患者连续性分级均为 1 级，纤维化信号强度分级均为 2 级及以上。[结论]急性前交叉韧带断裂镜下缝合和股骨双隧道悬吊固定技术可行，初步疗效满意，但远期疗效有待进一步观察。

Abstract:

[Objective] To present the surgical technique and preliminary outcomes of arthroscopic suture with double-tunnel suspension fixation of acute anterior cruciate ligament (ACL) rupture. [Methods] From January 2022 to January 2024, 12 patients with acute ACL injury were treated with the abovesaid technique. After successful anesthesia, arthroscopic examination was routinely performed. The ACL stump was knitted and sutured, and double bone tunnels were created from the anatomical sites the anteromedial and posterolateral bundles of the ACL on the lateral femoral condyle. The sutures were introduced through both tunnels to the outer cortex of the lateral condyle of the femur, the plate suture holes. Subsequently, the an Ethibond suture was introduced, which was passed through the anteromedial bone tunnel into the joint cavity, one end passes through the stump. At posterior drawer stress position with knee flexion of 30 degrees, the sutures were tighten over the suspension plate, until proper tensing on the ACL, finally the sutures were tied and secured. [Results] All patients had operation performed successfully without complications, and followed up for 12~24 months. The Lysholm [(49.7±6.7), (93.5±2.9), P＜ 0.001], IKDC [(50.8±5.2), (89.1±3.3), P＜0.001] and Tegner scores [(1.0±0.7), (5.3±1.1), P＜0.001] were significantly improved at the last follow-up compared with those before surgery. The MRI showed grade 1 ACL continuity in the12 patients, with grade 2 or above fibrosis signal intensity. [Conclusion] This arthroscopic suture with double-tunnel suspension fixation for acute ACL rupture is feasible technique with satisfactory preliminary consequence, however, the long-term outcomes need to observed further.