前交叉韧带重建膝关节本体感觉的恢复  

Proprioception restoration after anterior cruciate ligament reconstruction with remnant preservation

作　　者：周鹏[1] 邵宏斌[1] 杨勤旭 陈锋锋[1] 姚彦斌 李慎松[1] ZHOU Peng;SHAO Hong-bin;YANG Qin-xu;CHEN Feng-feng;YAO Yan-bin;LI Shensong(Department of Sports Medicine, 940 Hospital, Joint Logistics Support Center of the Chinese Peopled Liberation Army, Lanzhou 730050, China)

机构地区：[1]中国人民解放军联勤保障部队第940医院骨科中心运动医学科

出　　处：《中国矫形外科杂志》2019年第12期1073-1077,共5页Orthopedic Journal of China

基　　金：军队后勤科研面上项目(编号:CWH17J007)

摘　　要：[目的]观察前交叉韧带(anterior cruciate ligament, ACL)在急性损伤期保残重建对膝关节本体感觉恢复的影响。[方法]2015年1月~2015年12月ACL损伤并行重建的患者90例为研究对象。其中,45例患者损伤时间3周内采用保残重建,而另外45例患者损伤时间3周及以上采用去残重建。两组患者均选择相同术式并取自体腘绳肌腱行单束重建。术前及术后3、6及12个月随访时对患者行Lysholm评分及IKDC评分评估膝关节功能;同时采用Biodex S4行被动活动察觉阈值(TTDPM)、被动角度再生试验(JPS),评估膝关节本体感觉。[结果]术后所有患者均获得12个月以上随访,平均(15.25±6.46)个月。两组患者随时间延长Lysholm评分及IKDC评分显著增加,不同时间点差异有统计学意义(P<0.05),术后3、6个月时,保残组的Lysholm评分高于陈旧组,差异有统计学意义(P<0.05);术后两组TTDPM和JPS均随时间延长而显著改善(P<0.05),术后3、6及12个月保残组患者被动活动察觉阈值、被动角度再生试验与健侧相比差异无统计学意义(P>0.05),术后3个月去残组患者被动活动察觉阈值、被动角度再生试验高于健侧,术后12个月时基本等同于健侧。[结论]ACL急性损伤患者早期行保残重建有利于早期恢复膝关节功能及本体感觉。[Objective] To explore the effect of the remnant preservation in anterior cruciate ligament (ACL) reconstruction (ACLR) during acute stage on proprioception restoration.[Methods] A total of 90 patients who underwent ACLR for ACL injury were selected as the subjects of this prospective study during the period from January 2015 to December 2015. Of them 45 patients with ACL injury in 3 weeks received ACLR with the remnant preservation (RP), while the remaining 45 patients who had ACL tear more than 3 weeks had ACLR with the remnant removed (RR). The single bundle ACLR using hamstring tendon autograft was performed in both groups. The Lysholm and IKDC score was used to evaluate the function of the knee before, 3, 6 and 12 months after operation. In addition, the threshold to detection of passive motion (TTDPM) and joint position sense (JPS) by passive angle regeneration test were measured by using Biodex S4 to evaluate the proprioception of the knee joints.[Results] All the patients were followed up for more than 12 months with an average of (15.25±6.46) months. The Lysholm and IKDC scores in the two groups significantly increased as time went on postoperatively, with statistically significant differences among the times points (P<0.05), and the RP group was marked higher scores than the RR group at each corresponding time points postoperatively although no statistically significant differences were proved between them. Consistently, the TTDPM and JPS significantly improved over time postoperatively in both group (P<0.05), the RP group was significantly superior to the RR group at 3 and 6 months postoperatively (P<0.05). In the RP group no significant differences in the TTDPM and JPS were found between the affected and unaffected sides at 3, 6 and 12 months, by contrast, in the RR group the affected side was inferior to the unaffected side in the TTDPM and JPS at 3 months (P<0.05), although these became no significantly different at 12 months.[Conclusion] The early ACLR with the remnant preservation takes benefits

关 键 词：前交叉韧带损伤 保残重建 本体感觉 

分 类 号：R687.4[医药卫生—骨科学]