胫骨髓内钉固定后后交叉韧带重建的技巧

Technique of posterior cruciate ligament reconstruction after tibial intramedullary nail fixation

摘要:

[目的]介绍胫骨髓内钉固定术后重建后交叉韧带的手术技巧和初步临床结果。[方法]对 1 例患者行此手术，术前三维 CT、MRI 明确胫骨骨折类型及 PCL 断裂程度，在三维 CT 上进行 PCL 胫骨隧道测量及预演，术中根据术前的测量结果进行 PCL 胫骨端隧道钻取，钻取隧道前先取出胫骨髓内钉近端可能存在干扰的锁定钉，钻取隧道后检验两者间是否有会聚，如有则置入其他位置的锁定钉，如无则重新置入该枚锁定钉，术中应注意锁定髓内钉尾帽，避免灌洗液渗漏。[结果]患者顺利完成手术，术中术后无明显并发症。术后 IKDC 评分由术前 43 增加至术后 4 个月 59，Lysholm 评分由术前 27 增加至术后 4 个月 87，VAS 评分由术前 7 减少至术后 4 个月 2。[结论] 胫骨骨折合并同侧 PCL 断裂时，可根据上述手术方法早期重建 PCL，是安全且有效的手术方式。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical results of reconstruction of posterior cruciate ligament after tibial intramedullary nail fixation. [Methods] A patients underwent abovesaid surgical operation. Before operation, the type of tibial fracture and the degree of PCL fracture were determined by CT 3D and MRI, and the PCL tibial tunnel was measured and per-performed on CT 3D images. During the operation, PCL tibial tunnel was drilled according to the preoperative measurement data. After the tunnel was drilled, it was examined whether there was a convergence between the two. If there was a convergence, a locking screw was placed in another position, if not the screw was re-inserted. Attention should be paid to locking tail cap of the intramedullary nail during the operation to avoid leakage of lavage fluid. [Results] The patient had PCL reconstructed successfully without significant complications during and after operation. IKDC score increased from 43 before surgery to 59 at 4 months after surgery, Lysholm score increased from 27 before surgery to 87 at 4 months after surgery, and VAS score decreased from 7 before surgery to 2 at 4 months after surgery. [Conclusion] When tibia fracture is combined with ipsilateral PCL rupture, PCL can be reconstructed early according to the above surgical methods, which is a safe and effective surgical method.