膝关节镜下等离子射频皱缩术治疗膝关节交叉韧带松弛近期疗效观察

Early experience of thermal therapy in treatment of knee joint anterior cruciate ligament laxity under arthroscopy

目的对照研究膝关节镜下应用等离子射频皱缩法治疗单纯与合并其他膝关节结构损伤的交叉韧带松弛患者的疗效。方法2003年6月～2006年7月我科收治的41例交叉韧带松弛的患者．根据是否合并其他膝关节结构损伤分为单纯组（22例）和合并损伤组（19例）。术前、术后分别进行评分。疗效评估采用：KT-1000、Lysholm、Irrgang、改良larson、国际膝关节评分委员会（IKDC）韧带评分系统进行疗效评价。结果术后随访36例．失访5例，单纯损伤组19例．失访3例，平均随访26．9个月（5～44个月）。合并损伤组随访17例，失访2例，平均随访20．2个月（2～36个月）。单纯损伤组．Lachman试验均为阴性，KT-1000检查显示双侧膝关节前向松弛度差值〈3mm，IKDC评分活动水平正常或接近正常为18例（94．74％），Lysholm评分从（52．3±5．1）分提高至（89．8±5．2）分，Irrgang评分从（45．4±5．7）分提高至（79．4±6．2）分，Larson评分从（45、6±4．6）分提高至（89．6±5．3）分，和术前相比差异均有统计学意义（P〈0．01）。合并损伤组，其中16例患者（94．12％）Lachman试验阴性．KT-1000检查显示双侧膝关节前向松弛度差值〈3mm，IKDC评分活动水平正常或接近正常为16例（94．12％），Lysholm评分从（43．4±5．3）分提高至（75．4±6．1）分，Irrgang评分从（41．5±7．6）分提高至（70．4±5．4）分．Larson评分从（43．2±6．7）分提高至（71．3±8．4）分，和术前相比差异均有统计学意义（P〈0．01）。两组的术后Lysholm评分无显著性差异．Irrgang评分、Larson评分差异有统计学意义（P〈0．05）。结论单纯ACI，松弛病例与合并其他膝关节结构损伤的交叉韧带松弛病例在关节镜下应用等离子射频皱缩法进行治疗均可恢复交叉韧带的张力，提高膝关节的稳定性。若合并半月板、髁间脊骨折、退行性骨关节炎等损伤，经该法治疗后比单纯损伤组疼痛、肿胀严重，关节稳定性差。

Objective To perform a retrospective study for evaluating the clinical result of thermal therapy in the treatment of anterior cruciate ligament （ACL） laxity in the patients with or without combined injuries under arthroscopy. Methods Fourty-one patients with ACL lax were treated from February 2002 to January 2006 in our center. They were followed-up and divided into 2 groups： simple ACL injury （22 cases） and ACL lax with combined injuries （19 cases）. Clinical results were evaluated according to IKDC, Lysholm, Irgang and Larson scale. Sub-items of scales such as pain, swelling and laxity were specially evaluated. Results Time for follow-up was 5 to 44 months （mean 26.9 months）. All grafts were in good position according to roentgenograms at the time of follow-up. KT-1000 examination of affected knee showed less than 3mm anterior translation difference comparing to contralateral one. Simple ACL laxity group： 18 patients got normal IKDC score （94.74%）. Lysholm score （89.8±5.2）, Irgang score （79.4±6.2）, I.arson score （89.6±5.3）. Combined injuries group： 16 patients got normal IKDC score （94. 12%）. Lysholm score （75.4±6. 1）, Irgang score （70.4±5.4）, Larson score （71.3±8.4）. No significant statistical difference was found between the two groups in Lysholm scale （P〉0.05）. But there was significant statistical difference in Irrgang and Larson scale（P〈0.05）. Conclusions Thermal therapy is useful to both simple ACL laxity and ACL lax with combined injuries and knee stability may increase. But combined injuries such as meniscus, intercondylar spinous fracture, degenerative arthritis can influence therapeutic effect. Pain, swelling and joint stability scale are not better than simple ACL lax group.