关节镜辅助下膝关节交叉韧带损伤伴僵直同时进行松解及人工韧带重建的应用研究

Arthroscopic reconstruction of artificial ligament with simultaneous lysis of knee joint ankylosis for cuciate ligament injury

目的对膝关节交叉韧带损伤伴僵直的患者采用在关节镜辅助下同时松解及人工韧带重建术治疗与分期松解再重建两种方法进行疗效评价。方法对27例膝关节交叉韧带损伤伴僵直的患者进行了手术治疗，其中14例患者先行膝关节僵直松解术，术后进行功能锻炼，二期再行交叉韧带重建术（A组）；另外13例患者在关节镜下同时进行松解及人工韧带重建术（B组）。比较两组患者术后膝关节活动功能恢复情况和术后住院时间。结果术后膝关节活动度A组患者由术前的30°～75°（640°±3．7°）提高到90°～150°（1230°±8．5°），B组患者由术前的35°～80°（71．0°±3．5°）提高到90°～145°（1180°±91°），两组的差异无统计学意义（P〉0.05）；Lysholm评分A组患者由术前的45～70（610±41）分提高到80～95（860±56）分，B组患者由术前的51～72（630±45）分提高到78～94（840±53）分，两组的差异也无统计学意义（P〉O．05）。两组患者术后Lachman试验、前后抽屉试验、轴移试验均在正常范围。术后住院时间A组患者16～28（20．0±2．8）d，B组患者7～15（100±16）d，两组的差异有统计学意义（P〈0．05）。结论在关节镜辅助下同时松解及人工韧带重建术治疗膝关节交叉韧带损伤伴僵直，不但可以达到分期手术同样良好的疗效，而且可以消除患者二次手术的痛苦，缩短住院时间，减轻患者的经济负担，取得更好的整体效果。

Objective To evaluate the ettlcacy OT artnroscoplc reconstructlon of artiTiClal ligament with simultaneous surgical lysis of knee joint ankylosis in patients with cruciate ligament injury. Methods Total 27 patients with cruciate ligament injury and knee akylosis were enrolled in the study, 14 cases received surgical iysis for ankylosis and functional rehabilitation first, subsequently underwent reconstruction of artificial ligament （Group A）; 13 cases received lysis operation and cruciate ligament reconstruction simultaneously （Group B）, The function of knee joint and length of hospital stay were compared between two groups. Results In group A the movement of knee was 30°-75°（ 64.0° ± 3.7° ）before operation and reached to 90°～ 150°（123.0° ± 8.5°） after operation; those for group B were 35° ~80°（ 71.0° ± 3.5° ）and 90°～ 145°（118.0°± 9.1°）, respectively （ P 〉 0.05 ）. The Lachman test scores for group A were 45 N 70（ 61.0 ± 4.1 ） before operation and 80 ～ 95（ 86.0 ＋ 5.6 ）after operation; those for group B were 51～72（ 63.0 ± 4.5 ） and 78 N 94（ 84.0 ± 5.3 ）, respectively（P 〉 0.05 ）. The Lachman test, drawer test and pivot shift test scores were all in normal range after operation in both groups, The length of hospital say for group A was 16 - 28 （ 20,0±2.8 ）d ; that for group B was 7 ～ 15（ 10.0 ± 1.6 ）d（P〈 0,05 ）. Conclusion Arthroscopic reconstruction of artificial ligament with simultaneous lysis of knee akylosis is an effective approach and it can also reduce the length of hospital stay for patients with cruciate ligament injury.