改良Lemaire术式在轴移试验高度阳性的前交叉韧带重建中的应用  

Modified Lemaire procedure in anterior cruciate ligament reconstruction with highly positive pivot shift test

作　　者：王上增 刘昕岩[1] 宋明哲 郑博文 许文龙 程韶 WANG Shangzeng;LIU Xinyan;SONG Mingzhe;ZHENG Bowen;XU Wenlong;CHENG Shao(College of Orthopedics and Traumatology,Henan University of Chinese Medicine,Zhengzhou Henan,450000,P.R.China;Department of Arthropathy,Henan Provincial Hospital of Traditional Chinese Medicine,Zhengzhou Henan,450000,P.R.China)

机构地区：[1]河南中医药大学骨伤学院,郑州450000 [2]河南省中医院关节病科,郑州450000

出　　处：《中国修复重建外科杂志》2025年第4期434-439,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：河南省重点研发专项(241111311700);河南省自然科学基金青年项目(232300420269);河南省中青年卫生健康科技创新领军人才项目(LJRC2024020);河南省中医药科学研究专项课题(2023ZYZD06);河南省高校科技创新团队支持计划资助(24IRTSTHN040);河南省高等学校重点科研项目(24A360002);河南省中医院科学研究专项课题(2022ZY2026);郑州市科技惠民计划项目(2023KJHM0009)。

摘　　要：目的探讨改良Lemaire术式在轴移试验高度阳性的前交叉韧带重建术(anterior cruciate ligament reconstruction,ACLR)中应用的临床疗效。方法回顾分析2020年4月—2022年9月收治且符合选择标准的18例前交叉韧带(anterior cruciate ligament,ACL)断裂且轴移试验高度阳性患者临床资料。男13例,女5例;年龄17~41岁,平均28.3岁。致伤原因:直接暴力损伤11例,包括交通事故伤6例、运动损伤4例、高处坠落伤1例;间接暴力损伤7例,均为运动损伤。患者均为ACL完全断裂,其中急性损伤15例,陈旧性损伤3例。术前轴移试验Ⅱ级9例,Ⅲ级9例。均采用ACLR合并改良Lemaire术式治疗。术前及术后3、6、12个月,采用国际膝关节文献委员会(IKDC)评分、Lysholm评分评价临床疗效;采用KT-2000关节测量仪测量膝关节前方稳定性,并记录健患侧差值;采用轴移试验评价膝关节旋转稳定性。随访时摄膝关节X线片观察骨隧道及内固定物情况,MRI检查ACL、前外侧副韧带及腓侧副韧带移植物愈合情况。结果所有患者均顺利完成手术,未出现膝关节感染、血管神经损伤等并发症。18例均获随访,随访时间12~19个月,平均13.2个月。术后患者膝关节旋转稳定性恢复满意,末次随访时无膝关节失稳、交锁等不良症状。X线片和MRI示骨隧道解剖定位准确,愈合良好,内固定物位置良好,重建的ACL及髂胫束条带走行连续,张力良好。术后3、6、12个月IKDC评分、Lysholm评分及KT-2000健患侧差值均较术前显著改善(P<0.05);术后随时间延长各指标进一步改善,除IKDC评分术后3、6个月间以及KT-2000健患侧差值术后3个月与6、12个月间比较差异无统计学意义(P>0.05)外,其余各指标各时间点间差异均有统计学意义(P<0.05)。术后即刻及末次随访时轴移试验均为阴性。结论对于伴轴移试验高度阳性的ACL损伤患者,ACLR合并改良Lemaire术式能够有效恢复膝关节前外侧稳定性,术后Objective To explore the effectiveness of the modified Lemaire procedure in anterior cruciate ligament reconstruction(ACLR)in patients with a highly positive pivot shift test.Methods The clinical data of 18 patients with anterior cruciate ligament(ACL)rupture and highly positive pivot shift test between April 2020 and September 2022 were retrospectively analyzed.There were 13 males and 5 females with an average age of 28.3 years(range,17-41 years).Causes of injury included 11 cases of direct violence injury,including 6 cases of traffic accident injury,4 cases of sports injury,1 case of falling injury;7 cases of indirect violence injury,all sports injury.All patients had complete ACL rupture,including 15 acute injuries and 3 old injuries.The preoperative pivot shift test was gradeⅡin 9 cases and gradeⅢin 9 cases.All patients were treated with ACLR combined with modified Lemaire procedure.The International Knee Documentation Committee(IKDC)score and Lysholm score were used to evaluate the effectiveness before operation and at 3,6,12 months after operation.KT-2000 arthrometer was used to measure the anterior stability of the knee joint,and the difference between the healthy and affected sides was recorded.Pivot shift test was used to evaluate the rotational stability of the knee joint.During the follow-up,X-ray films were taken to observe the bone tunnel and internal fixation,and MRI was used to examine the healing of ACL,anterolateral collateral ligament and fibular collateral ligament grafts.Results All patients completed the operation successfully without complications such as knee joint infection,vascular and nerve injury.All patients were followed up 12-19 months(mean,13.2 months).After operation,the rotational stability of the knee joint recovered satisfactorily,and there was no adverse symptom such as knee instability and locking at last follow-up.X-ray film and MRI showed that the bone tunnel was anatomically located and healed well,the internal fixation was in good position,and the reconstructed ACL and

关 键 词：前交叉韧带重建 改良Lemaire术式 前外侧韧带 轴移试验 

分 类 号：R687.4[医药卫生—骨科学]