关节镜下非解剖型与理想化重建前交叉韧带治疗膝关节前交叉韧带断裂的临床效果观察  

Clinical Effect of Arthroscopic Non-anatomical and Idealized Reconstruction of Anterior Cruciate Ligament in the Treatment of Knee Anterior Cruciate Ligament Rupture

作　　者：张壮岱[1] 杨永兴[1] 冯志军[1] 野战涛[1] 赵芬[1] ZHANG Zhuang-dai;YANG Yong-xing;FENG Zhi-jun;YE Zhan-tao;ZHAO Fen(The Third Department of Osteology, 980 Hospital of PLA Joint Logistics Support Forces, Shijiazhuang 050082, China)

机构地区：[1]联勤保障部队第九八零(白求恩国际和平)医院骨三科,石家庄050082

出　　处：《临床误诊误治》2019年第5期82-87,共6页Clinical Misdiagnosis & Mistherapy

基　　金：石家庄市科技局课题(181460533)

摘　　要：目的探讨关节镜下非解剖型与理想化重建前交叉韧带治疗膝关节前交叉韧带断裂的临床效果。方法选择2008年3月—2015年5月行部分单侧前交叉韧带重建的膝关节交叉韧带断裂200例。采用配比病例对照研究方法,将2012年6月—2015年5月收治的采用理想化重建100例作为理想化组,在关节镜下利用4股腘绳肌肌腱经内侧附加入口理想化重建前交叉韧带。2008年3月—2012年5月收治的行非解剖型重建100例作为非解剖组,在关节镜下利用4股腘绳肌腱经胫骨隧道非解剖型重建前交叉韧带。观察两组前交叉韧带重建术后切口愈合、并发症、手术关节活动度及随访情况,比较两组手术前后膝关节功能情况及膝关节稳定性。结果两组随访18～30(24±6)个月,术后切口均愈合良好,无关节内感染、无下肢深静脉血栓形成及血管、神经损伤情况,移植物均为自体股薄肌及半腱肌腱。两组术前膝关节IKDC评分、Lysholm评分及前抽屉试验、Lachman试验、轴移试验阳性率比较差异均无统计学意义(P>0.05)。术后两组膝关节IKDC评分及Lysholm评分均高于术前,前抽屉试验、Lachman试验及轴移试验阳性率均低于术前,差异有统计学意义(P<0.05)。术后理想化组前抽屉试验、Lachman试验及轴移试验阳性率均低于非解剖组,差异有统计学意义(P<0.05);术后两组膝关节IKDC评分和Lysholm评分比较差异无统计学意义(P>0.05)。结论关节镜下采用腘绳肌腱理想化重建前交叉韧带治疗膝关节前交叉韧带断裂是一种恢复膝关节前后向及旋转稳定性的可靠方法。ObjectiveTo investigate the clinical effects of arthroscopic non-anatomic and idealized reconstruction of anterior cruciate ligament (ACL) in the treatment of ACL rupture in the knee joint. MethodsA total of 200 patients with ACL rupture in the knee joint who were treated with unilateral ACL reconstruction from March 2008 to May 2015 were enrolled in this study. And as a matched case-control study, 100 cases who underwent idealized ACL reconstructions in our hospital from June 2012 to May 2015 served as idealized group. Idealized ACL reconstruction was performed under arthroscope using 4-strand hamstring tendons through additional medial entrance. One hundred cases treated from June 2012 to May 2015 using non-anatomical reconstructors served as non-anatomical group. ACL was reconstructed by using the tendon of the 4-strand hamstring tendons under arthroscope through the tibial tunnel in a non-anatomical manner.Incision healing, complications, surgical joint mobility and follow-up were observed after ACL reconstruction. The knee function and knee stability were compared before and after operation. ResultsAll patients were followed up for 18 to 30(24±6) months postoperatively. The incisions were well-healed, without intra-articular infection, deep vein thrombosis of the lower extremities, or vascular and nerve injury. The grafts were all autologous semi tendon and femoral thin tendon. There were no significant differences in the preoperative knee IKDC score, Lysholm score, and the positive rates of the anterior drawer test (ADT), Lachman test and axial shift test between the two groups ( P >0.05). The knee joint IKDC score and Lysholm score were higher than those before operation, and the positive rates of ADT, Lachman test and axial shift test were lower than those before operation, suggesting significant differences ( P <0.05). The positive rates of ADT, Lachman test and axial shift test in the idealized group were lower than those in the non-anatomical group, and significant difference was found ( P <0.05). The

关 键 词：创伤和损伤 前交叉韧带重建 关节镜 

分 类 号：R641[医药卫生—外科学] R658[医药卫生—临床医学]