四、总结
1.PCL起自股骨内侧髁的外侧面,向后外方向走行,止于胫骨髁间棘后部。PCL呈两端粗大,中间细小的沙漏状结构,其平均长度约为38mm,最窄处的平均宽度约为11mm。
2.根据膝关节屈伸过程中PCL纤维束所表现出的不同紧张-松弛模式,可将PCL分为ALB与PMB。
3.PCL损伤为高能量损伤,临床工作中应格外留意是否合并其他韧带结构损伤。
4.PCL为限制胫骨后向位移的一级稳定结构。PCL损伤后,屈膝90°时胫骨后向位移显著增大。因此,临床上应采取屈膝90°位的后抽屉试验诊断PCL损伤。
5.股骨止点的位置对于PCL等长性影响大,临床上可通过关节镜下直视或纯侧位X线片进行定位,股骨髁间窝顶(Blumensaat线)与前方软骨边缘(股骨前皮质线)可作为相应的参考标志。
6.胫骨止点的位置关乎PCL重建术中的安全性。临床操作中主要依靠PCL的胫骨侧残端作为其胫骨止点定位的参考依据。此外,为避免PCL重建后胫骨隧道内口对移植物摩擦而产生的“杀手转弯”现象,术中常将PCL胫骨导向器置于胫骨平台关节面以下1.0～1.5cm处。
7.虽然生物力学测试结果显示Inlay技术显著优于Transtibial技术,但两种技术的临床对比结果仍未见显著差异。此外,由于Inlay技术操作难度大,血管、神经损伤风险高,目前Transtibial技术仍为PCL重建的首选技术。
8.生物力学结果显示,PCL双束重建技术相比单束重建技术在膝关节近伸直位与高度屈曲位能够更好地维持胫骨后向稳定性。然而,鉴于临床中PCL损伤常合并PLC损伤,且现有的高循证等级研究较少,目前针对单纯PCL损伤的最佳手术技术尚存争议。
(宋关阳)
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