Ⅰ期与Ⅱ期手术治疗伴内侧副韧带断裂的前交叉韧带损伤的临床效果观察  

Clinical Observation of the Effect of Surgical Treatment for Anterior Cruciate Ligament Injury with Medial Collateral Ligament Rupture in StagesⅠandⅡ

作　　者：庞龙 王雪臣[2] 王硕 李丁丁[1] PANG Long;WANG Xuechen;WANG Shuo;LI Dingding(Magnetic Resonance Laboratory,Tangshan People's Hospital,Tangshan,Hebei 063000,China;Department of Orthopedics,Tangshan People's Hospital,Tangshan,Hebei 063000,China)

机构地区：[1]唐山市人民医院磁共振室,河北唐山063000 [2]唐山市人民医院骨三科,河北唐山063000

出　　处：《临床误诊误治》2024年第15期68-73,85,共7页Clinical Misdiagnosis & Mistherapy

基　　金：河北省2019年度医学科学研究课题计划(20191584)。

摘　　要：目的比较伴内侧副韧带(MCL)断裂的前交叉韧带(ACL)损伤Ⅰ期与Ⅱ期手术治疗的效果。方法选取2021年9月至2023年10月收治的伴MCL断裂的ACL损伤患者89例,按手术时机分为Ⅰ期组45例和Ⅱ期组44例。Ⅰ期组患者早期采用关节镜下自体腘绳肌腱ACL重建术与MCL止点撕脱点固定,Ⅱ期组先制动4~6周后行关节镜下自体腘绳肌腱ACL重建术。观察2组手术优良率,比较手术前后膝关节功能[国际膝关节委员会(IKDC)、Lysholm、Tegner评分]、Lachman试验结果、轴移试验结果、应力位内侧间隙开大程度、患侧与健侧屈膝功能、步行时平衡及步态,记录2组术后并发症发生情况。结果Ⅱ期组术后12个月优良率[95.45%(42/44)]高于Ⅰ期组[80.00%(36/45)](P<0.05)。Ⅱ期组术后6、12个月IKDC、Lysholm、Tegner评分均高于Ⅰ期组,Lachman试验0级、轴移试验0级患者占比高于Ⅰ期组(P<0.05);Ⅱ期组术后6、12个月应力位内侧间隙开大程度0~5 mm患者占比高于Ⅰ期组,患侧与健侧屈膝差0°患者占比高于Ⅰ期组(P<0.05)。Ⅱ期组患侧步长、单腿支撑期、前足最大压力、足跟最大压力高于Ⅰ期组,足偏角小于Ⅰ期组(P<0.05)。2组并发症总发生率比较差异无统计学意义(P>0.05)。结论Ⅱ期手术治疗伴MCL断裂的ACL损伤患者效果确切,能改善关节稳定性、膝关节功能,且具有良好的安全性。Objective To compare the effects of surgical treatment for anterior cruciate ligament(ACL)injuries with medial collateral ligament(MCL)rupture in stageⅠand stageⅡ.Methods A total of 89 patients with ACL injury accompanied by MCL rupture who were admitted from September 2021 to October 2023 were selected and divided into stageⅠgroup(n=45)and stageⅡgroup(n=44)according to the timing of surgery.Patients in the stageⅠgroup underwent arthroscopic reconstruction of the ACL with autologous hamstring tendons and fixation of the MCL avulsion point.Patients in the stageⅡgroup underwent immobilization for 4-6 weeks before undergoing reconstruction of the ACL with autologous hamstring tendons.The excellent and good rate of surgery in the two groups was observed,and the knee joint function[International Knee Documentation Committee(IKDC),Lysholm,Tegner scores]before and after surgery,the results of the Lachman test,the results of the axial displacement test,the degree of opening of the medial gap under stress,the knee flexion function of the affected side and the healthy side,balance and gait during walking were compared.The occurrence of postoperative complications in the two groups was recorded.Results The excellent and good rate of the stageⅡgroup at 12 months after surgery[95.45%(42/44)]was higher than that of the stageⅠgroup[80.00%(36/45)](P<0.05).The IKDC,Lysholm,and Tegner scores in the stageⅡgroup were higher than those in the stageⅠgroup at 6 and 12 months after surgery,and the proportion of patients with Lachman test score of 0 and axial displacement test score of-0 was higher than that in the stageⅠgroup(P<0.05).The proportion of patients with a range of motion(ROM)of 0-5 mm in the medial gap at the stress position at 6 and 12 months after surgery in the StageⅡgroup was higher than that in the StageⅠgroup,and the proportion of patients with a difference of 0°between the affected and unaffected sides in knee flexion was higher than that in the StageⅠgroup(P<0.05).The step length,single l

关 键 词：前交叉韧带 创伤和损伤 内侧副韧带 膝 前交叉韧带重建 Lachman试验 轴移试验 手术后并发症 

分 类 号：R684.76[医药卫生—骨科学]