关节镜下双束解剖重建前交叉韧带的中期疗效观察  

Mid-term effects of arthroscopic anatomical reconstruction of double bundles of the anterior cruciate ligament

作　　者：周钢[1] 林坚平[1] 王广积[1] 方业汉 黄晖[1] 熊小龙[1] 沈宁江[1] 

机构地区：[1]海南省人民医院骨科中心关节外科,海口570311

出　　处：《中华创伤骨科杂志》2018年第1期80-84,共5页Chinese Journal of Orthopaedic Trauma

基　　金：海南省自然科学基金项目（20168282）

摘　　要：目的探讨关节镜下双束解剖重建前交叉韧带（ACL）的中期临床效果。方法回顾性分析2012年4月至2014年7月期间收治的78例ACL断裂患者资料。男60例，女18例；年龄为19～56岁，平均26．8岁。受伤至手术时间为l周至23个月，平均5．8个月。所有患者术前Lachman试验和轴移试验均为阳性，KT-1000检查显示双侧膝关节前向松弛度差值平均为（8．29±1．81）mm。所有患者均采用关节镜下自体胭绳肌腱双束解剖重建ACL。末次随访时按照国际膝关节文献委员会（IKDC）评分标准和Lysholm膝关节评分标准评定疗效。结果78例患者术后获25～56个月（平均34．6个月）随访。末次随访时78例患者的IKDC评分平均为（92．9±2．8）分，Lysholm膝关节评分平均为（94．2±3．4）分，均较术前[（42．6±9．5）、（44．4±8．5）分1显著提高，差异有统计学意义（P〈0．05）。末次随访时73例（93．6％）患者Lachman试验呈阴性，69例（88．5％）患者轴移试验呈阴性。KT-1000检查显示双侧膝关节前向松弛度差值平均为（1．47±0．68）mm，与术前比较差异有统计学意义（P〈0．05）。29例患者末次随访时行磁共振成像检查：所重建前内束和后外束连续。结论关节镜下双束解剖重建ACL能够有效地重建膝关节的稳定性，中期临床效果良好。Objective To investigate the mid-term clinical outcomes of artbroscopic anatomical reconstruction of double bundles of the anterior cruciate ligament （ACL）. Methods The clinical data of 78 patients diagnosed with ACL rupture from April 2012 to July 2014 were analyzed retrospectively. They were 60 males and 18 females, aged from 19 to 56 years （mean, 26.8 years） . The time from injury to surgery ranged from one week to 23 months （mean, 5.8 months）. All of them obtained positive results in anterior drawer test and Lachman test preoperatively. Their preoperative KT-1000 examinations showed an average side-to-side difference of 8.29 ± 1.81 mm in anterior laxity. They were all treated with arthroseopic anatomical recon- struction of double bundles of the anterior crueiate ligament using autologous hamstrings. The International Knee Documentation Committee （IKDC） and Lysholm scores were used to assess their knee function at the last follow-up. Results All the 78 patients were followed up for 34.6 months on average （range, from 25 to 56 months） . At the last follow-up, the IKDC and Lysholm scores were significantly increased from preoper- ative 42.6 ± 9.5 and 44. 4 ± 8.5 to postoperative 92. 9 ±2. 8 and 94.2 ± 3.4, respectively （ P 〈 0. 05）. The Lachman test was negative in 73 cases （93.6%） and the pivot shift test was negative in 69 cases （88.5%） . The KT-1000 examinations showed that the side-to-side difference in anterior laxity averaged 1. 47± 0. 68 mm, significantly improved from the preoperative values （ P 〈 0.05）. At their last follow-up, 29 patients underwent MRI scans which showed continuity of the anteromedial and posterolateral bundles of the anterior cruciate liga- ment. Conclusion The arthroscopic anatomical reconstruction of double bundles of the anterior eruciate ligament can restore the knee stability and achieve fine mid-term clinical outcomes.

关 键 词：膝关节 前交叉韧带 关节镜检查 解剖重建 双束 

分 类 号：R687.4[医药卫生—骨科学]