关节镜下保留前交叉韧带下止点残端单束重建的临床研究

Clinical study on the stump single-bundle reconstruction of cruciateligament under arthroscopic

目的探讨关节镜下应用自体腘绳肌腱行保留前交叉韧带残端单束重建治疗前交叉韧带损伤的近期临床效果,探讨前交叉韧带胫骨残端在重建术后韧带功能及膝关节本体感觉恢复过程中的作用,并对一些相关问题展开讨论。方法病例取自2010年1月至2011年2月,就诊于山西医科大学第二医院骨科诊断为"前交叉韧带损伤"的患者,共48例,其中46例获得随访,年龄16～44岁,平均27.80岁,其中男32例,女14例。受伤至手术时间为5～75天,平均25.85 d。对46例患者行关节镜下保留前交叉韧带下止点残端的单束重建手术治疗,股骨端应用带袢钢板固定,胫骨端应用可吸收界面螺钉固定。术后随访时通过前抽屉试验、Lachman试验、Lysholm膝关节评分评价膝关节的稳定性,2000年国际膝关节文献委员会(IKDC-2000)评分评价术后膝关节本体感觉恢复情况。结果 46例患者术后12个月随访,45例患者(97.82%)前抽屉试验阴性,43例患者(93.48%)Lachman试验阴性。Lysholm评分由术前平均(61.33±7.82)分改善至末次随访时(91.61±4.04)分(t=-22.720,P<0.001),IKDC-2000主观评分由术前平均(65.67±8.13)分改善至末次随访时(92.39±4.15)分(t=-18.298,P<0.001)。结论关节镜下保留前交叉韧带下止点残端单束重建手术,能够建立具有良好稳定性的膝关节,术后本体感觉较术前明显提高,近期临床疗效良好。是一种效果较好的手术方式。

Objective To investigate the short-term clinical effects of arthroscopic autologous hamstring ten-don and retention of anterior cruciate ligament injury in the single-bundle reconstruction treatment of the anterior cruciate ligament stump, and to explore the function of the anterior cruciate ligament tibial stump after reconstruc-tion of the ligament and knee proprioception role in the recovery process, and to discuss some related issues. Meth-ods From January, 2010 to February, 2011, 48 patients with anterior cruciate ligament rupture were retained in hospital and 46 of the patients aged 16-44 were followed up, 32 males and 14 females, mean age 27.80 years old. The duration from injury to operation was 5 to 75 days, with an average of 25.85 days. The 46 patients were opera-ted with arthroscopic anterior cruciate ligament stump single-bundle reconstruction, the femoral side applied with a loop of steel plate fixation and the tibial side with absorbable interference screw fixation. The postoperative follow-up was conducted to evaluate the postoperative effect by anterior drawer test, Lachman test, Lysholm knee score, and the score of the 2000 International Knee Documentation Committee （IKDC-2000）. Results with 46 patients followed up after 12 months, the anterior drawer test for 45 patients （97.82%） was negative, Lachman test for 43 patients （93.48%） was negative. Lysholm score was improved from preoperative average points （61.33! 7.82） to the last follow-up points （91.61 ± 4.04） （ t=-22.720, P〈0.001 ）, IKDC subjective score improved from preopera-tive average points （65.67±8. 13） to the last follow-up points （92.39±4.16） （t=-18. 298, P〈0. 001）. Oonclu-sion The arthroseopic anterior eruciate ligament stump single-bundle reconstruction surgery is a better way to reha-bilitate the stability of patients＇ knee joints, and has a good curative effect.