股骨侧功能偏心位固定前十字韧带重建术的早期疗效  

Clinical observation of functional eccentric interference screw fixation for reconstruction of anterior cruciate ligament

作　　者：马霄君 王卫明[1] Ma Xiaojun;Wang Weiming(Sports Medicine Service, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, China)

机构地区：[1]大连大学附属中山医院运动医学科,116001

出　　处：《中华骨科杂志》2019年第7期406-413,共8页Chinese Journal of Orthopaedics

基　　金：基金项目国家自然科学基金(30870647).

摘　　要：目的探讨关节镜下股骨侧功能偏心位固定前十字韧带重建术的早期疗效。方法回顾性分析2015年4月至2017年3月行自体腘绳肌腱重建前十字韧带的前十字韧带损伤患者35例,胫骨侧、股骨侧均采用挤压螺钉固定。根据股骨侧不同固定位置分为两组:功能偏心位固定16例,男9例、女7例,年龄(26.8±5.2)岁(范围21~36岁);解剖足印区中心固定19例,男11例、女8例,年龄(27.6±4.8)岁(范围18~35岁)。患者术前及术后1年行Lysholm膝关节评分评价膝关节功能;术前及术后1年行步态分析,测量膝关节屈伸、内外翻、内外旋角度;术后1年复查膝关节MRI,观察前十字韧带形态及张力。结果术后1年,功能偏心位固定组Lysholm评分由术前(58.5±5.5)分增加至(87.5±4.5)分,差异有统计学意义(t=18.532,P=0.014);足印区中心固定组Lysholm评分由术前(57.0±6.5)分增加至(89.0±5.0),差异有统计学意义(t=19.213,P=0.012);两组术前及术后1年Lysholm评分的差异均无统计学意义(P>0.05)。术后1年,功能偏心位固定组膝关节最大屈曲角度由术前的51.8°±4.5°增加至61.4°±3.5°,差异有统计学意义(t=8.532,P<0.001);足印区中心固定组膝关节最大屈曲角度由术前的51.2°±4.6°增加至62.2°±4.2°,差异有统计学意义(t=8.423,P<0.001)。功能偏心位固定组站立相中期平均屈曲角度(3.8°±2.1°)小于足印区中心固定组(8.5°±2.8°),差异有统计学意义(t=8.716,P<0.001)。功能偏心位固定组内外翻角度(8.6°±5.8°)与足印区中心固定组(5.4°±5.2°)比较差异无统计学意义(t=0.382,P=0.844)。功能偏心位固定组站立相中期平均外旋角度由术前10.5°±6.8°减小至-2.3°±4.1°,与术前比较差异有统计学意义(t=7.987,P<0.001),与足印区中心固定组(-2.1°±4.8°)比较差异无统计学意义(t=0.628,P=0.581)。结论关节镜下股骨侧功能偏心位固定前十字韧带重建,能有效恢复膝关节的功能及运动学特征。Objective To investigate the early stage clinical outcomes of reconstruction of the anterior cruciate ligament with functional eccentric fixation. Methods We retrospective reviewed the 35 patients with anterior cruciate ligament reconstruction from autologous hamstring tendon from April 2015 to March 2017. The humeral were fixed with interference screws and divided into two groups according to different fixation methods. The group I was fixed with functional eccentric interference screw, including a total of 16 cases (9 males and 7 females, mean age 26.8 years). The group II was fixed with anatomical foot print central fixation screw, including a total of 19 cases (11 males and 8 female, mean age 27.6 years). Lysholm scores were recorded before and 1 year postoperatively in group I and group II. Gait analysis of knee flexion and extension, varus and valgus, internal and external rotation angle, and the MRI was performed at 1 year after surgery to observe the clinical effects. Results The Lysholm score of the functional eccentric fixed group increased from preoperative 58.5±5.5 points to 87.5±4.5 points with statistically significant difference (t=18.532, P=0.014). The foot print central fixed group increased from preoperative 57.0±6.5 points to 89.0±5.0 points with statistically significant difference (t=19.213, P=0.012). There was no significant difference between the eccentric fixed group and the foot print central fixed group in postoperative function (t=0.968, P=0.067). In gait analysis, the maximum flexion angle of the knee joint was increased from 51.8°±4.5° to 61.4°±3.5° before operation in functional eccentric group (t=8.532, P<0.001). The average mid-standing angle in eccentricity group (3.8°±2.1°) was lower than that in the foot center group (8.5°±2.8°)(t=8.716, P<0.001). There was no significant difference in the angle of internal and external valgus between the functional eccentricity group (8.6°±5.8°) and the fixed position of the foot print group (5.4°±5.2°)(t=0.382, P=0.844).

关 键 词：前交叉韧带 关节镜检查 步态 

分 类 号：R687.4[医药卫生—骨科学]