越顶重建联合改良Lemaire技术治疗轴移试验阳性的前十字韧带损伤  

Over the top reconstruction combined with modified Lemaire technique in the treatment of anterior cruciate ligament injury with pivot-shift positive

作　　者：向先祥 李瑞欣 刘佳 魏志亨 弓爵 李春辉 齐婉晴 贾梦阳 陈维伊 杨莹 王卫明 Xiang Xianxiang;Li Ruixin;Liu Jia;Wei Zhiheng;Gong Jue;Li Chunhui;Qi Wanqing;Jia Mengyang;Chen Weiyi;Yang Ying;Wang Weiming(Department of Sports Medicine,Xinhua Hospital Affiliated to Dalian University(Institute of Sports Medicine,Dalian University/Dalian Sports Injury Diagnosis and Treatment Technology Innovation Center),Dalian 116021,China)

机构地区：[1]大连大学附属新华医院运动医学科(大连大学运动医学研究所,大连市运动损伤诊治技术创新中心),大连116021

出　　处：《中华骨科杂志》2024年第7期438-446,共9页Chinese Journal of Orthopaedics

基　　金：大连市医学重点专科登峰计划支持项目(2022004,2023002)。

摘　　要：目的探讨越顶重建联合改良Lemaire技术治疗轴移试验阳性的前十字韧带(anterior cruciate ligament,ACL)损伤的临床疗效。方法云回顾性分析2020年3月至2021年10月大连大学附属新华医院收治的ACL损伤伴轴移试验Ⅱ级及以上的患者46例,男28例、女18例,年龄(28.0±10.5)岁(范围15~45岁)。均为单侧,左膝17例、右膝29例。轴移试验Ⅱ级30例、Ⅲ级16例,致伤原因均为运动损伤。取半腱肌和股薄肌,行越顶联合改良Lemaire技术重建ACL。比较手术前后国际膝关节文献委员会(International Knee Documentation Committee,IKDC)评分、Lysholm评分及KT-2000侧-侧差值。结果所有患者均顺利完成手术并获得随访,随访时间为(26.6±2.3)个月(范围24~28个月)。患者术后3、24个月的Lysholm评分分别为(73.6±4.3)分、(91.6±2.8)分,大于术前的(58.5±4.6)分,差异有统计学意义(F=18.351,P<0.001)。患者术后3、24个月的IKDC评分分别为(59.0±2.0)分、(91.8±3.2)分,大于术前的(50.3±2.8)分,差异有统计学意义(F=17.290 P<0.001)。患者术后3、24个月的KT-2000侧-侧差值分别为(1.7±0.8)mm、(1.5±0.4)mm,小于术前的(5.9±1.1)mm,差异有统计学意义(F=14.192,P<0.001)。术后24个月时3例患者轴移试验I级,4例患者Lachman试验I级,但主诉膝关节稳定性良好,未进一步治疗。末次随访时无一例出现切口及关节内感染、深静脉血栓形成、膝关节僵硬、股四头肌骨化性肌炎、重建韧带断裂等并发症,所有患者均重返运动,重返运动时间为(15.7±2.6)个月(范围12~24个月)。结论越顶重建联合改良Lemaire技术治疗轴移试验阳性的ACL损伤可有效改善膝关节功能,促进患者重返运动,手术并发症发生率低。Objective To investigate the clinical efficacy of over-the-top reconstruction combined with the modified Le-maire technique in the treatment of anterior cruciate ligament(ACL)injuries with pivot-shift positive.Methods From March 2020 to October 2021,a total of 46 patients with ACL injury and pivot-shift test grade I or above were admitted to Xinhua Hospi-tal Affiliated to Dalian University.There were 28 males and 18 females,aged 28.0±10.5 years(range,15-45 years).All cases were unilateral,including 17 cases of left knee and 29 cases of right knee.The pivot-shift test showed that 30 cases were grade II and 16 cases were grade II,and the cause of injury was sports injury.The semitendinosus muscle and gracilis muscle were harvest-ed,and the ACL was reconstructed with the over-the-top combined modified Lemaire technique.The International Knee Docu-mentation Committee(IKDC)score,Lysholm score and KT-2000 side-to-side difference before and after operation were com-pared.Results All patients successfully completed the operation and were followed up for 26.6±2.3 months(range,24-28 months).The Lysholm scores of the patients at 3 months and 24 months afier operation were 73.6±4.3 and 91.6±2.8,which were higher than those before operation(58.5±4.6),and the difference was statistically significant(F=18.351,P<0.001).The IKDC scores of patients at 3 months and 24 months after operation were 59.0+2.0 and 91.8±3.2,respectively,which were higher than those before operation 50.3±2.8,and the difference was statistically significant(F=17.290,P<0.001).The side-to-side difference of KT-2000 was 1.7±0.8 mm and 1.5±0.4 mm at 3 and 24 months after operation,respectively,which was lower than that before operation(5.9+1.1 mm),and the difference was statistically significant(F=14.192,P<0.001).At 24 months after operation,3 patients had pivot shift test grade I and 4 patients had Lachman test grade I,but they complained of good knee stability and did not receive further treatment.At the last follow-up,there were no complications suc

关 键 词：前交叉韧带 创伤和损伤 前交叉韧带重建 

分 类 号：R686.5[医药卫生—骨科学]