前交叉韧带重建失败的影响因素分析  

Analysis of influence factor for the failure of anterior cruciate ligament reconstruction

作　　者：王健[1] 王海军[1] 林霖[1] 余家阔[1] WANG Jian;WANG Haijun;LIN Lin;YU Jiakuo(Institute of Sports Medicine,Beijing Key Laboratory of Sports Injuries,Peking University Third Hospital,Beijing,100191,P.R.China)

机构地区：[1]北京大学第三医院运动医学研究所北京大学第三医院运动医学关节伤病北京市重点实验室

出　　处：《中国修复重建外科杂志》2019年第12期1543-1546,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨性别、年龄、术后运动水平及移植物直径对前交叉韧带(anterior cruciate ligament,ACL)重建术疗效的影响。方法研究纳入2012年2月-2017年6月,于关节镜下行自体腘绳肌腱单束重建ACL2年以上、二次关节镜手术取出内固定物的179例患者。男111例,女68例;年龄11~63岁,平均30.0岁。患者均为运动损伤;受伤至手术时间3 d^26年,中位时间120 d。Lachman试验及轴移试验均为阳性。对性别、年龄、术后运动水平(取内固定物时Tegner评分)、移植物直径以及股数进行单因素分析,初步筛选ACL重建失败的影响因素;进一步采用logistic回归进行多因素分析,筛选危险因素。结果患者术后均获随访,随访时间24~90个月,平均29.1个月。末次随访时,Lachman试验阳性25例,轴移试验阳性28例。KT-2000检查双侧膝关节胫骨前向位移差值–1~7 mm,平均1.89 mm。根据ACL重建失败评价标准,共11例(6.15%)患者重建失败。单因素及多因素分析均显示年龄、性别、术后运动水平、移植物直径及股数不是ACL重建失败的影响因素(P>0.05)。结论 ACL重建术后不同年龄、性别、运动水平患者间重建失败风险无明显差异,而且通过增加股数方法增加移植物直径,对于降低重建失败率无显著意义。Objective To investigate the influence of gender, age, activity level, and diameter of graft on the anterior cruciate ligament(ACL) reconstruction. Methods Between February 2012 and June 2017, 179 cases(111 males and 68 females) with an average age of 30.0 years(range, 11-63 years) were included in study. The patients underwent internal fixator removal at 2 years or more after single bundle ACL reconstruction with hamstring tendon autografts. All patients were sports injuries. The time from injury to operation ranged from 3 days to 26 years(median, 120 days).Lachman test and pivot shift test were positive. Univariate analysis was conducted on gender, age, post-operative activity level(Tegner score at the time of internal fixator removal), diameter of graft, and number of graft strands, and logistic regression was used to conduct multivariate analysis to screen the independent risk factors. Results All patients were followed up 24-90 months(mean, 29.1 months). At last follow-up, Lachman test was positive in 25 cases and pivot shift test was positive in 28 cases. The KT-2000 side-to-side difference was –1-7 mm(mean, 1.89 mm). Eleven patients(6.15%)failed after ACL reconstruction. Univariate and multivariate analyses showed that the age, gender, post-operative activity level, diameter of graft, and number of graft strands were not risk factors for the failure of ACL reconstruction(P>0.05).Conclusion There was no significant difference in the risk for ACL reconstruction failure among age, gender, and activity level. ACL reconstruction failure rate cannot be reduced by increasing the number of graft strands to increase the diameter of grafts.

关 键 词：前交叉韧带 韧带重建 影响因素 

分 类 号：R68[医药卫生—骨科学]