残端鞘内重建前交叉韧带与不保留残端重建的对比研究  

Comparison of preserving versus resecting tibial remnant in single bundle anterior cruciate ligament reconstruction

作　　者：陈志伟[1] 邓焱[1] 侯子鑫[1] 

机构地区：[1]南华大学第一附属医院骨科,湖南衡阳421001

出　　处：《中国矫形外科杂志》2013年第4期321-326,共6页Orthopedic Journal of China

摘　　要：[目的]通过研究比较前交叉韧带保留残端重建与不保留残端重建的临床疗效。[方法]自2009年7月～2011年6月收治连续的68例选用自体腘绳肌腱作为移植物的ACL断裂患者,其中31例保留ACL残端行鞘内重建,37例未保留ACL残端(对照组)。术前体查前抽屉试验、Lachman实验及轴移试验均为阳性。术前及术后3、6、9、12个月及末次随访通过Lysholm评分、国际膝关节文献委员会膝关节评估表(IKDC)评分及膝关节韧带损伤专用的Marshall评分比较膝关节功能改善情况,KT-2000关节测量仪评价关节松弛度。[结果]保留残端鞘内重建组30例、对照组35例获1年以上完整随访。患膝关节不稳症状均消失,鞘内重建组轴移试验、Lachman实验均为阴性,对照组Lachman实验均为阴性,轴移试验阳性一例。测量患侧及健侧KT-2000,侧-侧差值<3 mm,两组患者术后各时间点侧-侧差值比较,差异无统计学意义(P>0.05);两组患者术后与术前Lysholm评分及IKDC功能评分比较差异均有统计学意义(P<0.05)。两组术后各时间点Lysholm评分及IKDC评分比较差异有统计学意义。两组末次随访时膝关节韧带损伤专用的Marshall评分比较,差异有统计学意义(P<0.05)。[结论]应用自体腘绳肌腱解剖鞘内重建前交叉韧带,能够建立具有高度稳定性的膝关节,有助于腱骨愈合及本体感觉的重建,并能早期促进术后膝关节功能的恢复。Abstract：[ Objective] To compare the outcome of anterior cruciate ligament （ACL） reconstruction with preserving versus removing the remnant of native ACL using hamstring autograft. [ Method] Between July 2009 and June 2011,68 consecutive pa- tients underwent ACL reconstruction using hamstring autograft. On the basis of the ACL＇s condition, patients were divided into 2 groups ： the tibial remnant preserving group （ n = 31 ） and the control group （ removing remnant, n = 37）. The results of the phys- ical examination anterior drawer test, positive Lackman test and pivot shift test before operation were all positive. Before opera- tion and at 3,6,9,12 months after operation and at last follow-up, the improvement of function of the knee joint was evaluated by Lysholm score, the International Knee Documentation Committee （IKDC） scale and Marshall score. KT -2000 arthrometer was used to evaluate knee laxity. [ Result] Thirty cases and 35 cases were completely followed up in the tibial-remnant preserving group and the control group, respectively. Knee joint instability disappeared, in the tibial-remnant preserving group, the patients showed negative in the pivot shift test and Lackman test. In the control group, 1 case of the pivot shift test showed positive and the Lackman test showed negative. By the evaluation of KT - 2000 the both sides arthrometer side-to-side difference was smaller than 3 mm. The comparative differences of the two groups at each time had no statiatic significance （P 〉 0.05 ）. However, differ- ences of the Lysholm score and IKDC scale between preoperation and postoperation of both patients groups had statiatic signifi- cance （P 〈 0.05 ）. Differences of the Lysholm score and IKDC scale at postoperative each time in both groups had statiatic sig- nificance（P 〈 0.05）. At last follow-up, the Marshall score in tibial-remnant preserving group was lager than in the control group, the differences were significant （ P 〈 0.05 ）. [ Conclusion ] Anatomic single-bund

关 键 词：前交叉韧带 自体腘绳肌腱 重建 

分 类 号：R687.2[医药卫生—骨科学]