KT1000/KT2000关节测量仪对前交叉韧带损伤诊断及重建术后移植物稳定性的评估价值

Evaluation of the diagnosis of anterior cruciate ligament injury and the graft stability after reconstruction by using KT1000/KT2000 arthrometer

目的:虽然前交叉韧带的重建手术已趋成熟,但重建术后韧带稳定性的量化评估仍缺乏一种有效的方法。探讨KT1000/KT2000关节测量仪在膝关节前交叉韧带损伤中的诊断价值以及在韧带重建术后移植物稳定性评估中的应用价值。方法:选择2006-01/2007-01于上海交通大学附属第六人民医院行关节镜下重建手术的膝关节前交叉韧带完全损伤患者80例,对治疗方案均知情同意。①术前利用KT1000/KT2000关节测量仪进行膝关节稳定性的测量,并与抽屉试验、Lachman试验、轴移试验及MRI影像学等检查方法进行对比,验证其敏感度。②分别在术后3个月、6个月、1年以及1年以上利用KT1000/KT2000关节测量仪进行随访测量,采用国际膝关节文献委员会评分对测量结果进行前交叉韧带的稳定性评估,评估标准:等级A为韧带紧张度良好;等级B为韧带紧张度接近正常;等级C为韧带紧张度异常;等级D为韧带紧张度严重异常。结果:80例前交叉韧带完全损伤患者全部进入结果分析。①KT1000测量仪在诊断前交叉韧带损伤时较前抽屉试验及轴移试验敏感率高(P=0.001,0.037),而与Lachman试验及MRI影像学检查敏感率差异无显著性意义(P=0.807,0.598)。②随访结果:术后3个月随访到80例患者,A级68例,B级12例;术后6个月随访到76例患者,A级55例,B级19例,C级1例;术后1年随访到70例患者,A级48例,B级20例;C级2例;术后1年以上随访到68例患者,A级42例,B级22例,C级4例。结论:KT1000/KT2000关节测量仪测量膝关节稳定性的敏感度较高,不仅可应用于膝关节前交叉韧带损伤的临床诊断,还可以评价手术效果,对前交叉韧带重建术后评估移植物稳定性提供了一个量化依据。

AIM： Anterior cruciate ligament （ACL） reconstruction is already developing, however the quantitative evaluation of ligament stability needs an effective method. This study is designed to explore the value of KT1000/KT2000 arthrometer in the diagnosis of ACL injury and its application to evaluate the graft of ACL reconstruction. METHODS： A total of 80 cases with ACL complete injury underwent arthroscopic reconstruction in the Six People＇s Hospital of Shanghai Jiao Tong University from January 2006 to January 2007. Informed consents were obtained from all the patients. ①AII the cases were tested by KT1000/KT2000 arthrometer before operation, and the results were compared with the clinical tests （drawer test, Lachman test, pivot test） and MRI to verify the sensitivity of this arthrometer.②After reconstruction, the KT1000/KT2000 arthrometer was also used to test the knee laxity at 3 months, 6 months, 1 year, and over 1 year. The results were evaluated by using the International Knee Documents Committee score： grade A： good; grade B： nearly normal; grade C： abnormal： grade D： severely abnormal. RFSULTS： Eighty cases of ACL complete injury all entered the result analysis. ①The accuracy of KT1000 arthrometer test was higher than that of drawer test and pivot test （P =0.001, 0.037）, while no significant difference was found compared with Lachman test and MRI （P =0.807, 0.598）.②Follow-ups： In 80 cases at 3 months, there were 68 cases of Grade A and 12 cases of Grade B; In 76 cases at 6 months, there were 55 cases of Grade A, 19 cases of Grade B, and 1 case of Grade C; and 70 cases at 1 year included 48 cases of Grade A, 20 cases of Grade B, and 2 cases of Grade C; 68 cases over 1 year included 42 cases of Grade A, 22 cases of Grade B, and 4 cases of Grade C. CONCLUSION： KT1000/KT2000 arthrometer, with its high sensitivity, can be used not only in the diagnosis of ACL injury, but also in the evaluation of the surgical result, providing a quantity basis for the graft stability after ACL reconstruction.