关节镜下清除和保留断裂前交叉韧带残端重建术后疗效对比  

Contrast the healing effect between removing and reserving the fractured anterior cruciate ligament under arthroscopy

作　　者：姚楚亮[1] 陈少文[1] 杨焱鑫[1] 王华仁[1] 曾辉[1] 陈杰[1] 廖臻[1] 杨炎彬 

机构地区：[1]武警广东省总队医院外六科,广州市510107

出　　处：《中华全科医学》2015年第4期550-552,F0003,共4页Chinese Journal of General Practice

摘　　要：目的 探讨前交叉韧带（anterior cruciate ligament,ACL）断裂予施行膝关节镜下ACL单隧道单束重建术,分析清除和保留断裂ACL残端术后的疗效是否存在差异,探索出更适合临床操作的手术方式。方法 2008年1月—2013年6月,对40例ACL断裂施行膝关节镜下单隧道单束ACL重建术,移植物均为取自同侧半腱肌和股薄肌编织成的自体韧带,其中20例（A组）为断裂ACL残端进行清除干净后再施行膝关节镜下单隧道单束ACL重建术,20例（B组）为断裂ACL残端进行尽可能保留前提下施行膝关节镜下单隧道单束ACL重建术,手术均为同一组医师完成,2组手术前后Lysholm评分和IKDC评分结果 进行t检验。结果 40例均获随访,时间为12-28个月,平均（20.7±3.7）个月,手术前后Lysholm评分和IKDC评分t检验结果 ,所得P=0.0183和P=0.0177,P值均〈0.05,比较差异有统计学意义。结论 ACL断裂采用清除和保留断裂前交叉韧带残端进行自体韧带重建术后的疗效,在关节平衡性、关节自体感觉恢复存在显著性差异。保留ACL残端进行单隧道单束重建ACL,有利于移植肌腱的胫骨和股骨端隧道口的制作;ACL固定于原ACL残端中,避免重建的ACL在髁间窝被撞击;原ACL残端纤维围绕重建的ACL,可以覆盖隧道内口,减少关节液对移植肌腱与隧道愈合的影响。Objective To explore the effect of single-tunnel single-bundle anterior cruciate ligament（ACL） reconstruction for ACL tear, compare the outcome of removing and reserving the fractured anterior cruciate ligament, and improve the clinical surgery. Methods The clinical data of 40 cases of ACL tear undergoing single-tunnel single-bundle ACE recon- struction under the arthroscopy in our hospital from January 2008 and June 2013 were reviewed retrospectively. The grafts were ipsilateral autologous semitendinosus and gracilis ligaments. 20 cases in group A received the removing of the fractured ACE,while another 20 cases in group B received reserving of the fractured ACL. Lysholm score and IKDC subjective score were performed and the T-test was used for comparison of means in two groups. Results All of the 40 cases are fol- lowed after the operation in 12 to 28 months （average 20.7± 3.7 months） ,The difference in Lysholm and IKDC between the two groups before and after the operation was significant（P = 0. 0183 and P = 0.0177 ）. Conclusion The difference in joints stability and proprioception restore of joints is significant between the two surgery methods with or without reserving fractured anterior cruciate ligament for ACL tears. The retention of ligament stump is benefit for the location of tendon graft and the production of femoral tunnel;When ACL is fixed behind the primary ACL stub should avoid the reconstructed ACL being pinched in femoral intercondylar fossa. The primary ACL stub fibers around the reconstructed ACL can close the tunnel, thus decrease the potential influence of joint fluid on the tendon graft and healing of tunnel.

关 键 词：关节镜 前交叉韧带重建 半腱肌肌腱 股薄肌肌腱 

分 类 号：R684[医药卫生—骨科学] R687.4[医药卫生—外科学]