前外侧肌腱固定联合单束重建术治疗伴高度轴移的前交叉韧带损伤  

Anterolateral tenodesis fixation combined with single-bundle reconstruction for treatment of anterior cruciate ligament injury with high-grade pivot-shift

作　　者：洪钟源 黄中强 王俊 温海华 邓怀东 HONG Zhong-yuan;HUANG Zhong-qiang;WANG Jun;WEN Hai-hua;DENG Huai-dong(SectionⅠ,Dept of Orthopaedics,Dongguan Hospital of Traditional Chinese Medicine,Dongguan,Guangdong 523000,China)

机构地区：[1]东莞市中医院骨一科,广东东莞523000

出　　处：《临床骨科杂志》2024年第6期796-800,共5页Journal of Clinical Orthopaedics

基　　金：广东省中医药管理局科研项目(编号:20231365);广东省东莞市科技局社会发展科技项目(编号:20221800900102)。

摘　　要：目的探讨改良Lemaire前外侧肌腱固定联合单束重建术治疗伴高度轴移的前交叉韧带(ACL)损伤的疗效。方法将79例伴高度轴移的ACL损伤患者根据治疗方法不同分为联合重建组(40例,采用改良Lemaire前外侧肌腱固定联合单束重建术治疗)和单纯重建组(39例,采用单纯单束重建术治疗)。采用Lachman试验、中立位前抽屉试验以及轴移试验评价膝关节稳定性情况。采用Lysholm评分和IKDC评分评价膝关节功能。记录并发症发生情况。结果患者均获得随访,时间12~24个月。患者术后Lachman试验、中立位前抽屉试验均为阴性。末次随访时,轴移试验两组均较术前改善(P<0.05),两组比较差异均有统计学意义(P<0.05);Lysholm评分、IKDC评分分级两组与术前比较差异均有统计学意义(P<0.01),两组比较差异均无统计学意义(P>0.05)。单纯重建组术后发生2例移植物再断裂,1例对侧ACL断裂,3例半月板术后再撕裂;联合重建组未发生相关并发症。结论改良Lemaire前外侧肌腱固定联合单束重建术治疗伴高度轴移的ACL损伤,可提高膝关节旋转稳定性,降低了残留轴移不稳的发生率及整体再手术率,并通过分散应力避免关节内的ACL移植物在韧带化过程中因受过高张力作用而发生再撕裂。Objective To investigate the efficacy of modified Lemaire anterolateral tenodesis fixation combined with single-bundle reconstruction on the anterior cruciate ligament(ACL)injury with high-grade pivot-shift.Methods The 79 cases who suffered from ACL injuries with high-grade pivot-shift were divided into combined reconstruction group(40 cases were performed with modified Lemaire anterolateral tenodesis fixation combined with single-bundle reconstruction)and the simple reconstruction group(39 cases were adopted with single-bundle reconstruction alone).Lachman test,anterior drawer test in neutral position,and pivot-shift test were used to assess the stability status of knee joints.Results All patients were followed up for 12~24 months.Postoperative Lachman test,anterior drawer test in neutral position of two groups were all negative.At the last follow-up,the results of the pivot-shift test of two groups were improved than the preoperation(P<0.05),and there was statistical difference between two groups(P<0.05).The Lysholm score and IKDC score of the two groups had statistical differences,compared with those before surgery(P<0.01),but there were no statistical differences between the two groups(P>0.05).In the simple ACL reconstruction group,there were 2 cases of graft re-rupture,1 case of contralateral ACL rupture,and 3 caess of meniscal re-tears;and no related complications occurred in the combined reconstruction group.Conclusions ACL injury with high-grade pivot-shift is treated with modified Lemaire anterolateral tenodesis fixation combined with single-bundle ACL reconstruction,which can improve the rotational stability of the knee,reduce the incidence rate of residual pivot-shift instability and the overall re-operation rate,and prevent the intraarticular ACL graft from re-tearing due to high tension during ligamination by distributing stress.

关 键 词：前交叉韧带损伤 单束重建 轴移试验 改良Lemaire 前外侧肌腱固定 

分 类 号：R686.5[医药卫生—骨科学] R687.2[医药卫生—外科学]