关节镜下异体腘绳肌腱保留残端重建前交叉韧带的近期疗效  

Short-term effectiveness of arthroscopic anterior cruciate ligament reconstruction using hamstring tendon allograft with remnant preservation

作　　者：张振君 贺明[1] 白伦浩[1] 

机构地区：[1]中国医科大学附属盛京医院关节外科及运动医学科,沈阳110022

出　　处：《中国骨与关节杂志》2017年第9期665-668,共4页Chinese Journal of Bone and Joint

摘　　要：目的探讨关节镜下异体腘绳肌腱保留残端重建前交叉韧带(anterior cruciate ligament,ACL)的手术方法及近期疗效。方法回顾分析2013年1月至2015年12月,我院经治的76例关节镜下异体腘绳肌腱保留残端单束重建ACL病例。男53例,女23例;年龄18~51岁,平均30.4岁。左膝50例,右膝26例。术前诊断ACL损伤51例,术中诊断25例。伤后至手术的时间2天至4.5年,平均1.3个月。关节镜下保留未损伤束支及残端采用异体腘绳肌腱重建ACL,术后随访检查患膝关节活动度,并按照Lysholm评分和国际膝关节评分委员会(IKDC)膝关节评分标准,Larson评分对患者膝关节功能恢复情况进行评价。结果76例均获12~34个月的随访,平均19个月。术后均I期愈合,无感染、高热及明显排斥反应发生。4例术后出现患侧关节积液,2周内经抽取关节液保守治疗后积液消失。2例出现前抽屉试验阳性,其余患者膝关节稳定性良好。Lysholm评分从术前(43.4±4.3)分提高至(86.4±6.4)分,IKDC评分正常72例(94.74%),Larson评分从术前(45.3±5.5)分提高至(85.4±4.8)分。所有患者轴移试验均为阴性,关节活动度正常。结论关节镜下保留ACL残端,进行ACL重建有利于维持膝关节稳定性,患者主观功能恢复良好,近期疗效显著。Objective To investigate the short-term effectiveness of arthroscopic anterior cruciate ligament （ ACL ） single-bundle reconstruction using hamstring tendon allograft with remnant preservation. Methods The clinical data were retrospectively analyzed from 76 patients treated by arthroscopic anterior cruciate ligament reconstruction using hamstring tendon allograft with remnant preservation from January 2013 to December 2015. There were 53 males and 23 females with an average age of 30.4 years （ range： 18 - 51 years ）, including 50 cases of left knees, 26 cases of right knees. Fifth-one cases were diagnosed preoperatively while 25 cases during the operation. The disease duration lasted from 2 days to 4.5 years （ mean, 1.3 months ）. Rolimeter test, Lysholm scores and international knee documentation （ IKDC ） grading were used for the evaluation before the operation and in the follow up. Results All the 76 patients were followed up for 12 - 34 months （ mean, 19 months ）. All incisions healed by the first intention. No fever, infection or rejection reaction occurred. Postoperative synovial fluid appeared in 4 cases, and disappeared after its removal in 2 weeks and conservative treatment. Anterior drawer test was positive in 2 cases. Lachman test was negative in all cases. Lysholm scores were increased from （ 43.4 ±4.3 ） pre-operation to （ 86.4 ± 6.4 ） post-operation. Seventy- two patients got normal IKDC scores （ 94.74% ）. Larson scores were increased from （ 45.3 ± 5.5 ） pre-operation to （ 85.4 ± 4.8 ） post-operation. Pivot shift test of all patients was negative. Joint range of motion was normal. Conclusions Arthroscopic anterior cruciate ligament reconstruction with remnant preservation is beneficial for the stability of the knee and further recovery, and the short-term effectiveness is satisfied.

关 键 词：关节镜 前交叉韧带重建 同种异体移植物 膝关节 

分 类 号：R687.4[医药卫生—骨科学] R616.5[医药卫生—外科学]