过顶位重建骨骺未闭合患者前交叉韧带损伤的临床疗效  

Clinical Application of Over-The-Top Reconstruction Technique in Patients with Unclosed Epiphysis and Anterior Cruciate Ligament Injury

作　　者：李世林 卢明峰[1,2] 周杰 赵立连[1,2] 何利雷 李炎烨 Li Shilin;Lu Mingfeng;Zhou Jie;Zhao Lilian;He Lilei;Li Yanye(The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine,Foshan 528000,China;Foshan Hospital of Traditional Chinese Medicine,Foshan 528000,China)

机构地区：[1]广州中医药大学第八临床医学院,广东佛山528000 [2]佛山市中医院运动医学科,广东佛山528000

出　　处：《实用骨科杂志》2025年第2期115-120,137,共7页Journal of Practical Orthopaedics

摘　　要：目的分析过顶位(over the top,OTT)重建技术治疗骨骺未闭合患者膝关节前交叉韧带(anterior cruciate ligament,ACL)损伤的临床疗效。方法筛选2018年12月至2022年12月在佛山市中医院接受OTT技术行ACL重建并随访1年以上的59例未成年患者,男40例,平均年龄(14.21±1.55)岁;女19例,平均年龄(13.08±0.61)岁。记录手术时间、术后出血量、住院天数、患者及家属满意度、重返运动率、重返运动时间及MRI影像学情况。比较术前及术后3个月、6个月、12个月、末次随访的Lysholm评分、国际膝关节评分委员会(international knee documentation Committee,IKDC)、Tegner评分及KT-1000差值。比较术前及术后12个月前抽屉试验、Lachman试验、轴移试验。记录并发症情况。结果术后随访15~25个月,平均(20.61±2.54)个月。手术时间(96.56±25.31)min,术后引流量(21.65±5.82)mL,住院天数(5.36±1.21)d。术后患者满意44例,一般11例,不满意4例。术后重返运动52例,平均重返运动时间(12.92±0.90)个月。术后1年MRI提示完全愈合52例,部分愈合7例。末次随访Lysholm评分、IKDC评分、Tegner评分较术前高,KT-1000差值较术前低(P<0.05);前抽屉试验、Lachman试验、轴移试验均较术前改善(P<0.05)。术后2例患者发生移植物再断裂,未见双下肢发育异常、感染、关节腔积血等并发症。结论采用OTT技术重建骨骺未闭合ACL断裂患者能够获得较好的膝关节稳定性和功能,患者满意度、重返运动率高。Objective To analyze the clinical efficacy of over the top(OTT)reconstruction technique in treating anterior cruciate ligament(ACL)injuries in patients with open epiphyses.Methods 59 underage patients who underwent OTT ACL reconstruction at Foshan Hospital of Traditional Chinese Medicine from December 2018 to December 2023 and were followed up for more than one year were selected.There were 40 males with an average age of(14.21±1.55)years and 19 females with an average age of(13.08±0.61)years.The operation time,postoperative bleeding volume,hospital stay,patient and family satisfaction,return-to-sport rate,return-to-sport time,and MRI imaging were recorded.The Lysholm score,international knee documentation committee(IKDC)score,Tegner score,and KT-1000 difference were compared before and 3 months,6 months,12 months,and at the last follow-up after surgery.The anterior drawer test,Lachman test,and pivot shift test were compared before and 12 months after surgery.Complications were recorded.Results The average follow-up time was 15~25(20.61±2.54)months.The operation time was(96.56±25.31)min;the postoperative drainage volume was(21.65±5.82)mL;the hospital stay was(5.36±1.21)days.Postoperatively,44 patients were satisfied,11 were generally satisfied,and 4 were dissatisfied.Fifty-two patients returned to sports,with an average return-to-sport time of(12.92±0.90)months.One-year postoperative MRI showed complete healing in 52 cases and partial healing in 7 cases.At the last follow-up,the Lysholm score,IKDC score,and Tegner score were higher than those before surgery,and the KT-1000 difference was lower than that before surgery(P<0.05);the anterior drawer test,Lachman test,and pivot shift test were all improved compared with those before surgery(P<0.05).Two patients had graft re-rupture after surgery,and no complications such as abnormal development of both lower extremities,infection,or hemarthrosis were observed.Conclusion The OTT technique can achieve good knee stability and function in patients with open epiphys

关 键 词：过顶位 前交叉韧带 自体肌腱 骨骺未闭合 

分 类 号：R687.4[医药卫生—骨科学]