关节镜下前交叉韧带重建联合同种异体半月板移植的中期疗效分析  

Mid-term effectiveness of arthroscopic anterior cruciate ligament reconstruction combined with meniscus allograft transplantation

作　　者：丁云鹏 章亚东[1] 贾海港 顾东强 陈磊[1] DING Yunpeng;ZHANG Yadong;JIA Haigang;GU Dongqiang;CHEN Lei(Department of Joint and Sports Medicine,the Fourth Medical Center of General Hospital of Chinese PLA,Beijing,10004& P.R.China)

机构地区：[1]解放军总医院第四医学中心关节与运动医学科

出　　处：《中国修复重建外科杂志》2019年第9期1071-1076,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：首都卫生发展科研专项项目(首发2018-1-5021)~~

摘　　要：目的总结关节镜下前交叉韧带(anterior cruciate ligament,ACL)重建联合同种异体半月板移植术治疗半月板严重损伤伴ACL断裂的中期疗效。方法回顾分析2007年2月—2014年12月,21例接受ACL重建联合同种异体半月板移植治疗并随访5年以上的患者临床资料。男12例,女9例;年龄18~45岁,平均23.5岁。致伤原因:运动扭伤15例,摔伤4例,交通事故伤2例。受伤至手术时间为2~36个月,平均12个月。其中15例患者既往行半月板切除术,与该次手术间隔3个月~6.5年,平均1.6年。21例均为初次ACL重建。术前前抽屉试验、Lachman试验、轴移试验均为阳性。Lysholm评分为(43.6±10.2)分,国际膝关节文献委员会(IKDC)评分为(60.50±14.06)分。术前MRI关节软骨分级:Ⅰ~Ⅱ级10例,Ⅲ级11例。结果术后患者均获随访,随访时间5.1~7.8年,平均5.5年。术后出现下肢麻木2例,切口轻度渗液3例,关节活动弹响2例,运动锻炼后关节轻度肿胀、疼痛5例。末次随访时,Lachman试验阴性18例,阳性3例;前抽屉试验阴性19例,阳性2例;轴移试验均为阴性。Lysholm评分为(84.5±16.5)分,IKDC评分为(85.25±4.60)分,均明显高于术前(P<0.01)。患侧膝关节屈曲、伸直分别达(128±13)、(3±7)°,活动范围均小于健侧(133±15)、(0±5)°(P<0.01)。KT-1000测试膝关节屈曲30、90°时患侧胫骨前移距离分别为(2.35±1.20)、(1.60±1.15)mm,与健侧(1.20±1.10)、(1.10±1.03)mm比较,差异均无统计学意义(P>0.01)。MRI复查示ACL移植物位置正常,同种异体半月板存活良好;关节软骨分级Ⅰ~Ⅱ级18例,Ⅲ级3例。结论对于半月板严重损伤伴ACL断裂患者,同种异体半月板移植联合ACL重建能恢复关节稳定性,同时半月板功能的恢复有利于保护关节软骨,中期疗效良好。Objective To summarize the mid-term effectiveness of arthroscopic anterior cruciate ligament(ACL)reconstruction combined with meniscus allograft transplantation. Methods A clinical data of 21 patients treated with arthroscopic ACL reconstruction and meniscus allograft transplantation and followed up more than 5 years between February 2007 and December 2014 was retrospectively analyzed. There were 12 males and 9 females, aged from 18 to 45 years, with an average age of 23.5 years. The cause of injury was sport sprain in 15 cases, falling in 4 cases, and traffic accident in 2 cases. The time from injury to operation ranged from 2 to 36 months, with an average of 12 months. Among them, 15 patients underwent previous meniscectomy, with an average interval of 1.6 years(range, 3 months to 6.5 years).All patients were primary ACL reconstruction. Preoperative anterior drawer test, Lachman test, and pivot shift test were positive. Lysholm score was 43.6±10.2. International Knee Documentation Committee(IKDC) score was 60.50±14.06. Of the 21 patients, 10 were gradeⅠ-Ⅱcartilage injuries and 11 were grade Ⅲ cartilage injuries according to MRI. Results All patients were followed up 5.1-7.8 years, with an average of 5.5 years. There were 2 cases of numbness of lower extremity,3 cases of slight exudation of incision, 2 cases of articular movement bounce, 5 cases of mild joint swelling and pain after exercise. At last follow-up, Lachman tests were negative in 18 cases and positive in 3 cases;anterior drawer tests were negative in 19 cases and positive in 2 cases;pivot shift tests were negative in all cases. Lysholm score was 84.5±16.5 and IKDC score was 85.25±4.60, which were significantly higher than those before operation(P<0.01). The flexion and extension of the affected knee joint were(128±13) and(3±7)°, respectively, which were smaller than those of the healthy knee joint [(133±15),(0±5)°](P<0.01). The results of KT-1000 test showed that when knee flexion was 30 and 90°, tibial anterior displacement of affec

关 键 词：半月板 前交叉韧带 同种异体移植 韧带重建 关节镜 

分 类 号：R687.4[医药卫生—骨科学]