膝关节镜下应用不同自体材料重建前交叉韧带对患者的影响  

Influence of anterior cruciate ligament reconstruction with different autologous materials under knee arthroscopy on perioperative indicators,knee function and imaging changes of patients

作　　者：夏正东 宋义 鄢含坤 杨仕红 钟吉彦 XIA Zhengdong;SONG Yi;YAN Hankun;YANG Shihong;ZHONG Jiyan(Department of Joint Surgery,Minda Hospital Affiliated to Hubei University for Nationalities,Enshi 445000,Hubei,China;Department of Orthopedics,Wuhan Fourth Hospital,Wuhan 430000,China)

机构地区：[1]湖北民族大学附属民大医院关节外科,湖北恩施445000 [2]武汉市第四医院骨科,湖北武汉430000

出　　处：《西部医学》2023年第8期1173-1177,共5页Medical Journal of West China

基　　金：湖北省自然科学基金项目(2018CFB208)。

摘　　要：目的 探究膝关节镜下应用不同自体材料重建前交叉韧带(ACL)对患者围术期指标、膝关节功能和影像学变化的影响。方法 回顾性分析2019年1月—2021年1月湖北民族大学附属民大医院收治的124例重建ACL患者临床资料,根据患者使用自体材料进行分组,观察组实施自体腘绳肌腱(半腱肌+股薄肌)移植重建(n=62),对照组实施自体半腱+1/2腓骨长肌移植重建(n=62)。探究两组患者围术期指标(手术时长、切口长度、术中出血量、编织后移植物直径)差异;比较两组患者治疗前、治疗3个月后、治疗6个月后膝关节功能Lysholm评分差异;分析两组患者治疗6个月后影像学变化差异;分析两组患者术后并发症差异。结果 观察组患者手术时长、切口长度、术中出血量、编织后移植物直径均低于对照组(P<0.05);治疗3、6个月后两组患者Lysholm评分均较治疗前上升(P<0.05),治疗3个月后观察组患者Lysholm评分高于对照组(P<0.05),治疗6个月后两组患者Lysholm评分比较差异无统计学意义(P>0.05);治疗6个月后,膝关节X线检查结果的影像学变化比较差异无统计学意义(P>0.05);两组患者膝前痛、伸膝受限、切口感染、胫骨骨道偏移、关节肿胀发生情况比较差异无统计学意义(P>0.05)。结论 自体腘绳肌腱移植重建与自体半腱+1/2腓骨长肌移植重建相比,对重建ACL患者围术期影响更小,且不影响患者早期膝关节功能恢复,常规情况下无需切取腓骨长肌腱来重建ACL,但对于腘绳肌腱比较细的患者可以考虑选择自体半腱+1/2腓骨长肌移植重建。Objective To explore the influence of anterior cruciate ligament(ACL)reconstruction with different autologous materials under knee arthroscopy on perioperative indicators,knee function and imaging changes of patients.Methods The clinical data of 124 patients with ACL reconstruction treated in the hospital from January 2019 to January 2021 were retrospectively analyzed.The patients were grouped based on the use of autologous materials,and the observation group underwent autologous hamstring tendon(semitendinosus+gracilis)transplantation reconstruction(n=62),and the control group received autologous semitendinosus+1/2 peroneus longus muscle transplantation reconstruction(n=62).The differences in perioperative indicators(surgical time,incision length,intraoperative blood loss,graft diameter after braiding)were explored in the two groups of patients.The differences in knee function(Lysholm score)were compared between the two groups before treatment and after 3 months and 6 months of treatment.The differences in imaging changes of the two groups were analyzed after 6 months of treatment,and the postoperative complications of the two groups were analyzed.Results The surgical time,incision length,intraoperative blood loss and graft diameter after braiding in observation group were shorter or less than those in control group(P<0.05).After 3 months of treatment and 6 months of treatment,the Lysholm scores of the two groups of patients were higher than those before treatment(P<0.05),and the Lysholm score in observation group was higher than that in control group after 3 months of treatment(P<0.05),but there was no significant difference in Lysholm score between the two groups after 6 months of treatment(P>0.05).After 6 months of treatment,the difference in knee X-ray examination was not significant(P>0.05).There were no significant differences in the occurrence of anterior knee pain,knee extension limitation,incision infection,tibial canal deviation and joint swelling between the two groups of patients(P>0.05).Conclusion C

关 键 词：膝关节镜 自体材料 重建 前交叉韧带 围术期 膝关节功能 

分 类 号：R685[医药卫生—骨科学]