后交叉韧带重建术后影响膝骨关节炎进展的因素分析  

Study of factors on the progression of knee osteoarthritis after posterior cruciate ligament reconstruction

作　　者：刘芷麟 高竞宇 严承远 赵其纯 Liu Zhilin;Gao Jingyu;Yan Chengyuan;Zhao Qichun(Department of Orthopaedics,Anhui Provincial Hospital,Hefei 230001,China)

机构地区：[1]安徽医科大学附属省立医院骨科,合肥230001 [2]安徽医科大学附属省立医院

出　　处：《骨科临床与研究杂志》2024年第6期350-356,共7页Journal Of Clinical Orthopedics And Research

摘　　要：目的研究后交叉韧带重建术(PCLR)后膝骨关节炎(KOA)进展情况,并探究其影响因素。方法回顾性分析2011年11月到2018年12月在安徽省立医院骨科采用自体肌腱移植物行PCLR的52例患者临床及影像学资料。收集患者一般资料,功能评分量表,膝关节胫骨相对后移最大差值。对术前患侧及末次随访时患侧与健侧正侧位片行影像学评估。评估患者术前及末次随访时的生活质量及功能评分差异及末次随访时KOA进展情况,并分析KOA进展的影响因素。结果本研究患者随访60~156(88.4±19.7)个月,末次随访时膝关节功能评分及膝关节活动度均显著高于术前(P<0.05)。根据Kellgren-Lawrence分级,末次随访时患侧KOA进展患者有18例(34.6%),仅2例(11.1%)KOA进展2级,16例(88.9%)KOA进展1级。膝关节后向松弛差值>3 mm[Exp(B)=9.907,P<0.05],受伤至手术时间>2个月[Exp(B)=5.446,P<0.05]为KOA进展的影响因素。结论PCLR可以明显改善患者生活质量及功能情况,术后患者满意度较高,但少部分患者PCLR术后会发生KOA,主要发生于髌股关节和胫股关节内侧间室。PCLR术后KOA进展与患者的术后膝关节松弛情况以及受伤至手术的时间有关。Objective To study the progression of knee osteoarthritis(KOA)after posterior cruciate ligament reconstruction(PCLR)and to investigate the factors affecting it.Methods The clinical and imaging data of 52 patients with PCLR who underwent autologous tendon graft in the Department of Orthopaedics,Anhui Provincial Hospital from November 2011 to December 2018 were retrospectively analyzed.Patient baseline parameters,functional rating scales,and posterior tibial laxity difference of the knee were collected.Preoperative and lateral radiographic images of the affected side and healthy side were evaluated.Differences in patients'quality of life and functional scores at preoperative and final follow-up and the progression of knee osteoarthritis at the final follow-up were assessed and regression analyses were performed to determine the factors influencing the progression of KOA.Results The patients in this study were followed up of 60-156(88.4±19.7)months,and the knee function scores and knee mobility were significantly greater at the final follow-up than preoperatively(P<0.05).According to the Kellgren-Lawrence grading,there were 18 patients(34.6%)with osteoarthritis progression in the affected knee at the last follow-up,only 2 patients(11.1%)had grade 2 osteoarthritis progression,and 16 patients(88.9%)had grade 1 osteoarthritis progression.A posterior tibial laxity difference of>3 mm[Exp(B)=9.907,P<0.05]and an injury-to-operation time of>2 months[Exp(B)=5.446,P<0.05]were influencing factors for the progression of KOA.Conclusion PCLR can significantly improve patients'quality of life and functional status,and postoperative patient satisfaction is high.However,a small number of patients develop OA after posterior cruciate ligament reconstruction,mainly in the medial compartment of the patellofemoral and tibiofemoral joints.The progression of KOA after PCLR is related to the patient's postoperative laxity of the knee joint as well as the time between the injury and surgery.

关 键 词：后交叉韧带重建术 膝骨关节炎 功能评分 影像学评估 

分 类 号：R684.3[医药卫生—骨科学]