前交叉韧带包膜内急性断裂非手术治疗的临床研究  

Non-operative Treatment for Acute Intra-synovial Sheath ACL Rupture

作　　者：马勇[1] 张家豪[1] 王海军[1] 蒋艳芳[1] 王永健[1] 何震明[1] 敖英芳[1] Ma Yong;Zhang Jiahao;Wang Haijun;Jiang Yanfang;Wang Yongjian;He Zhenming;Ao Yingfang(Institute of Sports Medicine, The Third Hospital of Peking University, Beijing 100191, China)

机构地区：[1]北京大学第三医院运动医学研究所,北京100191

出　　处：《中国运动医学杂志》2018年第1期10-13,共4页Chinese Journal of Sports Medicine

摘　　要：目的:针对性选择前交叉韧带(anterior cruciate ligament,ACL)包膜内急性断裂的非专业运动员患者,研究非手术治疗达到愈合的效果及可行性。方法:2014年5月至2016年7月,门诊诊断ACL包膜内急性断裂患者28例纳入研究。所有患者均戴支具限制胫骨前移6周,然后进行膝关节活动度练习并继续用支具保护。诊后3月MRI显示连续性完全恢复,胫骨前向松弛度差值小于5 mm的患者在诊后6月及12月继续随访稳定性并进行MRI评估,最终进行临床功能评分。结果:4例患者在诊后3月未达到要求退出治疗,其中3例接受手术重建,1例接受肌力训练等保守治疗。1例在诊后5月再伤,接受手术重建。23例患者达到临床愈合。诊后12月,胫骨前向松弛差值平均为2.1 mm(0~4 mm)。MRI评估1级8例,2级15例,优良率85.2%。主观IKDC评分平均为92.71(89.7~98.9)。Lysholm膝关节评分平均为91.6(86~95)。改良Larson膝关节韧带损伤评分平均为96.4(92~99)。结论:ACL急性包膜内断裂经过系统的非手术治疗,影像学显示愈合优良率较高,膝关节的稳定性可满足一般运动需要。Objective To evaluate the effectiveness of non-operative treatment for the acute intra-sy-novial sheath anterior cruciate ligament（ACL） rupture. Methods Twenty-eight patients diagnosed asthe acute intra-synovial sheath ACL rupture at outpatient clinic between May 2014 and July 2016 were included. All patients were immobilized with knee braces for 6 weeks,followed by range of mo-tion（ROM） training and partial to full weight-bearing of knees. All patients returned 3 months laterfor MRI scanning and those with the side-to-side difference of the anterior-posterior laxity less than 5 mm continued with non-operative treatment,followed up for MRI examination and clinical assessments6 and 12 months later. Results Four patients dropped out because they didn＇t meet the stability crite-ria at 3 months after the treatment,3 of whom received surgical reconstruction and 1 with musclestrengthening training. Another patient received surgical reconstruction at 5 months due to re-injury.The remaining 23 patients achieved satisfactory results at 12 months after the treatment,with the aver-age side-to-side difference of the anterior-posterior laxity of 2.1 mm（0-4 mm）,MRI good-to-excellentrate of 85.2%（8 of Grade 1 and 15 of Grade 2）,subjective IKDC（International Knee DocumentationCommittee） score of 92.71（89.7-98.9）,Lysholm score of 91.6（86-95）,and modified Larson score96.4（92-99）. Conclusions Patients with the acute intra-synovial sheath anterior cruciate ligament（ACL） rupture showed satisfactory functional scores and objective stability and healing on MRI afterthe non-operative treatment.

关 键 词：前交叉韧带 包膜内断裂 MRI 非手术治疗 

分 类 号：R873[医药卫生—运动医学]