关节镜下内减张技术辅助解剖单束重建后交叉韧带结合快速康复治疗后交叉韧带断裂的临床疗效  

Clinical outcome of arthroscopic anatomic single bundle reconstruction of posterior cruciate ligament assisted by internal tension relieving technique combined with rapid rehabilitation in the treatment of posterior cruciate ligament rupture

作　　者：余洋[1] 赵正吕 谢冰[2] 施政良 王国梁[1] 熊波涵 谷梓铭 刘津瑞 李彦林[1] Yu Yang;Zhao Zhenglyu;Xie Bing;Shi Zhengliang;Wang Guoliang;Xiong Bohan;Gu Ziming;Liu Jinrui;Li Yanlin(Department of Sports Medicine,First Affiliated Hospital of Kunming Medical University,Kunming 650032,China;Department of Obstetrics,First Affiliated Hospital of Kunming Medical University,Kunming 650032,China)

机构地区：[1]昆明医科大学第一附属医院运动医学科,昆明650032 [2]昆明医科大学第一附属医院产科,昆明650032

出　　处：《中华创伤杂志》2023年第7期593-602,共10页Chinese Journal of Trauma

基　　金：云南省骨关节疾病临床医学中心项目(ZX2019-03-04);云南省领军人才项目(L-201601);云南省重大科技专项计划项目(202102AA100015)。

摘　　要：目的比较关节镜下内减张技术辅助解剖单束重建后交叉韧带(PCL)结合快速康复与解剖单束重建结合常规康复治疗PCL断裂的临床疗效。方法采用回顾性队列研究分析2016年9月至2020年9月昆明医科大学第一附属医院收治的88例PCL断裂患者的临床资料,其中男65例,女23例;年龄18~55岁[(39.3±10.8)岁]。44例采用关节镜下内减张技术辅助解剖单束重建PCL结合快速康复治疗(减张组),44例采用关节镜下解剖单束重建PCL结合常规康复治疗(传统组)。比较两组术前及术后3,12,24个月国际膝关节文献委员会(IKDC)评分、美国特种外科医院(HSS)评分、Lysholm评分、膝关节的运动周期(最大步长、最小步长、步频)和膝关节6个运动学指标(前屈后伸角、内外旋角、内外翻角、上下位移、内外位移、前后位移)。比较两组术后12个月二次关节镜检查Marburger关节镜评分(MAS)和敖英芳教授改良评分。观察围术期并发症情况。结果患者均获随访24~36个月[(25.5±6.3)个月]。术后3个月减张组和传统组IKDC评分分别为(71.8±9.8)分、(68.5±6.5)分,术后12个月分别为(87.6±6.0)分、(87.6±5.5)分,术后24个月分别为(95.5±3.1)分、(92.8±11.6)分,较术前的(48.1±16.9)分和(47.1±15.0)分逐渐升高(P均<0.05);各时间点两组间差异无统计学意义(P均>0.05)。术后3个月减张组和传统组HSS评分分别为(74.2±6.2)分、(68.4±9.5)分,术后12个月分别为(91.9±5.4)分、(88.4±4.7)分,术后24个月分别为(97.1±2.0)分、(96.2±2.8)分,较术前的(57.5±17.7)分和(56.8±14.3)分逐渐升高(P均<0.05);术后3,12个月减张组HSS评分显著高于传统组(P均<0.01),其余时间点两组间差异无统计学意义(P均>0.05)。术后3个月减张组和传统组Lysholm评分分别为(74.2±14.9)分、(70.3±7.5)分,术后12个月分别为(90.9±6.1)分、(88.7±4.7)分,术后24个月分别为(96.9±3.0)分、(96.3±2.8)分,较术前的(48.7±20.7)分和(48.2±19.9)分逐Objective To compare the clinical efficacies between arthroscopic anatomic single bundle reconstruction of posterior cruciate ligament(PCL)assisted by internal tension relieving technique combined with rapid rehabilitation and anatomic single bundle reconstruction combined with conventional rehabilitation in the treatment of PCL rupture.Methods A retrospective cohort study was used to analyze the clinical data of 88 patients with PCL rupture admitted to First Affiliated Hospital of Kunming Medical University from September 2016 to September 2020.The patients included 65 males and 23 females,aged 18-55 years[(39.3±10.8)years].Forty-four patients underwent arthroscopic anatomic single bundle reconstruction of PCL assisted by internal tension relieving technique combined with rapid rehabilitation therapy(tension-relieving group),and 44 patients underwent arthroscopic routine anatomic single bundle reconstruction of PCL combined with conventional rehabilitation(traditional group).The two groups were compared before and at 3,12,and 24 months after surgery regarding the following items:International Knee Literature Committee(IKDC)score,Hospital for Special Surgery(HSS)score,Lysholm score,knee motion cycle(maximum stride length,minimum stride length,and stride frequency)and 6 kinematic indicators(angle of forward and back extension,angle of internal and external rotation,angle of internal and external rotation,up and down displacement,internal and external displacement,and forward and back displacement).The Marburger arthroscopy score(MAS)and Professor Ao Yingfang′s improved score by secondary arthroscopy were compared between the two groups at 12 months after surgery.The perioperative complications were observed.Results All patients were followed for 24-36 months[(25.5±6.3)months].In tension-relieving group and the traditional group,the values of IKDC score were(71.8±9.8)points and(68.5±6.5)points at 3 months after surgery,(87.6±6.0)points and(87.6±5.5)points at 12 months after surgery,and(95.5±3.1)points and(

关 键 词：膝损伤 后交叉韧带重建 关节镜 内减张技术 

分 类 号：R686.5[医药卫生—骨科学]