关节镜下保留胫骨侧残端重建前交叉韧带的疗效  

Efficacy of arthroscopic reconstruction of the anterior cruciate ligament with preserving tibial lateral stump

作　　者：吕欣[1] 苏日娜[2] 孙智文[1] 张一波 张爱民[1] LU Xin;SU Ri-na;SUN Zhi-wen;ZHANG Yi-bo;ZHANG Ai-min(Dept of Bone Joint,the Municipal Hospital of Chifeng City,Chifeng,Inner Mongolia 024000,China)

机构地区：[1]赤峰市医院骨关节科,内蒙古赤峰024000 [2]赤峰市医院麻醉科,内蒙古赤峰024000

出　　处：《临床骨科杂志》2023年第4期528-532,共5页Journal of Clinical Orthopaedics

基　　金：内蒙古自治区自然科学基金(编号:2020MS08144);内蒙古自治区赤峰市科协自然科学科研课题(编号:SZR21183)。

摘　　要：目的 观察关节镜下保留胫骨侧残端重建前交叉韧带(ACL)的疗效。方法 采用关节镜下保留胫骨侧残端重建ACL治疗58例ACL断裂患者。采用前抽屉试验、Lachman试验评价膝关节稳定性。采用Tegner运动分级评分、IKDC膝关节功能主观评分和Lysholm评分评价膝关节功能。结果 患者均获得24个月随访。术后3、6、12、24个月前抽屉试验及Lachman试验均为(-)。末次随访时,Tegner运动分级评分与术前比较差异无统计学意义(P>0.05);IKDC膝关节功能主观评分、Lysholm评分均较术前明显提高(P<0.05);患者膝关节活动度屈曲120°~140°(130.42°±7.26°)、伸直0°;MRI检查显示ACL走行均正常。结论 关节镜下保留胫骨侧残端重建ACL治疗ACL断裂,一方面可促进移植物血管再生、神经纤维长入重建的韧带,利于移植肌腱再血管化、爬行替代和膝关节本体感觉的建立;另一方面由于残端韧带对重建韧带的包裹,避免了关节液侵袭骨隧道,更利于膝关节稳定性和功能恢复。Objective To observe the effect of arthroscopic reconstruction of anterior cruciate ligament(ACL)by preserving tibial lateral stump.Methods The 58 patients with ACL ruptures were treated by ACL reconstruction with preserving tibial lateral stump under arthroscope.The stability of knee joint was evaluated by anterior drawer test and Lachman test.Tegner motion grading score,IKDC knee joint function subjective score and Lysholm score were used to evaluate knee function.Results All patients were followed up for 24 months.The results of anterior drawer test and Lachman test were both negative at 3,6,12,and 24 months after operation.At last follow-up,there was no significant difference in Tegner movement grade score when compared with that before operation(P>0.05).The IKDC subjective knee function score and Lysholm score were significantly increased than those before operation(P<0.05).The range of motion of knee flexion was 120°~140°(130.42°±7.26°),and the range of extension was 0°.MRI showed that the ACL course was normal.Conclusions Arthroscopic ACL reconstruction with tibial stump preservation for ACL rupture can promote graft revascularization and nerve fiber ingrowth into the reconstructed ligament,which is beneficial to the revascularization of the transplanted tendon,crawling substitution and the establishment of knee proprioception.On the other hand,due to the wrapping of the reconstructed ligament by the stump ligament,the invasion of synovial fluid into the bone tunnel is avoided,which is more conducive to the recovery of knee joint stability and function.

关 键 词：关节镜检查 膝关节 前交叉韧带重建 保留残端重建 

分 类 号：R686.5[医药卫生—骨科学] R687.2[医药卫生—外科学]