前交叉韧带损伤关节镜下重建术中保留残端与清除残端的前瞻性对照研究  

A Prospective Controlled Study of Stump Preservation Versus Stump Removal in Arthroscopic Reconstruction of Anterior Cruciate Ligament Injuries

作　　者：周晓武 李健旺 朱伟民[2] 钟名金 ZHOU Xiaowu;LI Jianwang;ZHU Weimin;ZHONG Mingjin(Longgang District Fifth People's Hospital,Shenzhen 518111,Guangdong China;Shenzhen Second People's Hospital,Shenzhen 518025,Guangdong China)

机构地区：[1]深圳市龙岗区第五人民医院,广东深圳518111 [2]深圳市第二人民医院

出　　处：《中国中医骨伤科杂志》2024年第6期62-67,共6页Chinese Journal of Traditional Medical Traumatology & Orthopedics

基　　金：深圳市第二人民医院临床研究项目(2023yjlcyj030)。

摘　　要：目的:采用前瞻性对照研究方法探讨关节镜下前交叉韧带(ACL)损伤重建术中保留残端与清除残端的临床应用价值。方法:前瞻性选取2020年1月至2022年6月ShermanⅠ型前交叉韧带损伤患者102例,按照随机数字表法分组,各51例。均行关节镜下前交叉韧带重建术,术中保留残端的51例患者作为保留组,术中清除残端的51例患者作为清除组。比较两组术后疼痛视觉模拟量表(VAS)评分、手术前后膝关节功能、膝关节稳定性(KT-2000评分、Berg平衡量表(BBS)评分)、本体感觉(屈曲15°,45°,75°关节位置感觉测定值(JPS))及并发症发生情况。结果:两组术后24 h、48 h、72 h VAS评分较术前下降,保留组低于清除组,差异均有统计学意义(P<0.05);两组术后1个月、3个月、6个月膝关节活动度、Lysholm评分、IKDC评分、KT-2000、BBS评分较术前升高,保留组高于清除组,差异均有统计学意义(P<0.05);两组术后1个月、3个月、6个月屈曲15°,45°,75°感觉测定值较术前降低,保留组低于清除组,差异均有统计学意义(P<0.05);保留组并发症发生率低于清除组,差异有统计学意义(P<0.05)。结论:ShermanⅠ型前交叉韧带损伤患者关节镜下重建术中保留残端能减轻术后疼痛,改善膝关节活动度、关节功能,增强膝关节稳定性及本体感觉,且并发症较少。Objective:To investigate the clinical value of stump preservation versus stump removal in arthroscopic reconstruction of anterior cruciate ligament(ACL)injuries using a prospective controlled study method.Methods:102 patients with Sherman type Ⅰ ACL injuries were prospectively selected from January 2020 to June 2022,and were grouped into 51 cases each according to the randomized numerical table method.All patients underwent arthroscopic ACL reconstruction,and 51 patients with residual end were included in the retention group and 51 patients with residual end were included in the removal group.Postoperative pain(VAS)score,knee function before and after surgery,knee stability(KT-2000 score,Berg Balance Scale(BBS)score),proprioception(JPS of 15°,45°,75° flexion)and complications were compared between the two groups.Results:VAS scores at 24 h,48 h and 72 h after surgery were lower than those before surgery,and those in retention group were lower than those in clearance group(P<0.05).Knee joint motion,Lysholm score,IKDC score,KT-2000 score and BBS score of 1 month,3 months and 6 months after surgery were higher than those before surgery,and those in the retention group were higher than those in the clearance group(P <0.05).JPS of 15°,45° and 75° flexion at 1 month,3 months and 6 months after surgery were lower than those before surgery,and the JPS of retention group was lower than that of clearance group(P<0.05).The complication rate of retention group was lower than that of clearance group(P<0.05).Conclusion:Preservation of the stump during arthroscopic reconstruction in patients with Sherman type Ⅰ ACL injuries reduces postoperative pain,improves knee mobility,joint function,enhances knee stability and proprioception,and has fewer complications.

关 键 词：前交叉韧带损伤 关节镜下前交叉韧带重建术 保留残端 清除残端 

分 类 号：R686.5[医药卫生—骨科学]