前交叉韧带重建术后膝关节功能及三维运动步态分析  

Function and three-dimensional gait analysis of knee after anterior cruciate ligament reconstruction

作　　者：赵立连[1] 卢明峰 邢基斯[1] 何利雷[1] 许挺[1] 王昌兵[1] Zhao Lilian;Lu Mingfeng;Xing Jisi;He Lilei;Xu Ting;Wang Changbing(Department of Sports Medicine, Foshan Hospital of Traditional Chinese Medicine, Foshan 528000, China)

机构地区：[1]佛山市中医院运动医学科,528000

出　　处：《中华关节外科杂志（电子版）》2021年第1期23-32,共10页Chinese Journal of Joint Surgery(Electronic Edition)

摘　　要：目的探讨前交叉韧带(ACL)重建术后膝关节稳定性、功能及三维步态运动学情况。方法回顾性分析2015年7月到2017年7月在佛山市中医院运动学科采用自体腘绳肌腱行ACL重建并进行了二次关节镜探查的270例病例,其中男164例,女106例。采用Lysholm评分、国际膝关节评分委员会(IKDC)评分、Tenger评分、膝关节损伤和骨关节炎(KOOS)评分、Lachman试验、轴移试验及KT-1000侧-侧差值评价膝关节功能及稳定性;比较膝关节6-自由度运动学参数,以客观评估术后膝关节功能;二次关节镜观察移植物连续性、移植物滑膜覆盖情况,分析移植物形态与膝关节功能、运动步态的相关性;分析患者术后重返运动情况及其影响因素。计数资料比较采用卡方检验,计量资料采用t检验。结果270例患者平均随访时间为(26±11)个月,1例出现术后感染,经关节镜清理、置管引流后痊愈,其余病例均未发生感染、移植物吸收等并发症。所有患者末次随访平均Lysholm评分、IKDC主观评分、Tegner评分、KOOS的功能、生活质量、疼痛、日常生活及症状评分、IKDC客观评分、轴移试验、Lachman试验、和KT-1000侧-侧差值均较术前明显改善(t=71.13、15.08、45.94、15.73、21.72、15.25、23.69、36.30、532.19、432.00、444.30、214.65,均为P<0.05);二次关节镜探查191例前交叉韧带完整,79例重建韧带部分撕裂,230例韧带紧张,40例韧带松弛,220例移植物滑膜覆盖为优,50例为差。末次随访时所有患者的膝关节6自由度运动学参数(内外翻、内外旋、屈伸、上下位移、内外位移和前后位移范围)明显优于术前(t=2.54、-8.67、11.06、-17.44、2.80、2.94,均为P<0.05);滑膜覆盖优组其Lysholm评分、IKDC评分、Tegner评分及KT-1000侧-侧差值及膝关节6自由度运动学参数(内外旋角度和前后位移的范围)均优于滑膜覆盖差组(t=13.50、7.69、20.05、12.69,均为P<0.01;t=3.97、8.23,均为P<0.05)。�Objective To investigate the knee joint stability,function and three-dimensional gait kinematics after anterior cruciate ligament reconstruction.Methods A retrospective analysis of 270 cases of ACL reconstruction and secondary arthroscopy was performed in the sports department of Foshan Traditional Chinese Medicine from July 2015 to July 2017.There were 164 males and 106 females.Lysholm score,International Knee Documentation Committee(IKDC)score,Tenger scale,knee injury and osteoarthritis outcome(KOOS)score,Lachman test,axle shift test and KT-1000 were used to evaluate function and stability of the knee.Six free domofmotion(6-DOF)was compared to evaluate the postoperative knee joint function objectively.Graft continuity,graft synovial coverage,and abnormal structure were observed in the joint during second look.The relationship between the morphology of the graft and the function and kinematics feature of the knee was analysed.The rate of return-to-sport(RTS)was caculated and the influencing factors were compared with those failed to RTS.Enumeration data were compared using the chi-square test,the quantity data were compared by t test.Results The average follow-up time of 270 patients was(26±11)months.One patient developed postoperative infection,which was cured by arthroscopy,catheterization and drainage.The other patients had no complication such as infection or graft absorption.At the last follow-up,Lysholm score,IKDC subjective score,Tegner score,KOOS(function score,quality of life,pain score,daily life,symptom score),IKDC objective evaluation,axial shift test,Lachman test and KT-1000 side to side difference in the last follow-up of all the patients were significantly improved compared with those before operation(t=71.13,15.08,45.94,15.73,21.72,15.25,23.69,36.30,532.19,432.00,444.30,214.65,all P<0.05).During the second look,191 patients had intact anterior cruciate ligament while other 79 patients had reconstructed ligament with partial tear.ACL of 230 patients demonstrated good tension while the others show

关 键 词：前交叉韧带重建 膝 运动 

分 类 号：R68[医药卫生—骨科学]