前交叉韧带保留残端重建术对膝关节本体感觉功能恢复的疗效分析

EFFECTIVENESS OF ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH REMNANT PRESERVATION ON PROPRIOCEPTION RESTORATION OF KNEE

目的 比较前交叉韧带（anterior cruciate ligament,ACL）保留残端重建与不保留残端重建术后膝关节本体感觉功能恢复情况。方法 将2010年1月-2012年10月收治的符合选择标准的40例ACL损伤患者随机分为2组,试验组关节镜下行自体腘绳肌腱ACL保留残端单束重建术,对照组行传统ACL单束重建术,每组20例。两组患者性别、年龄、病程、致伤原因及术前Lysholm评分、国际膝关节文献委员会（IKDC）评分比较,差异均无统计学意义（P〉0.05）,具有可比性。术后随访时行IKDC评分及Lysholm评分评定膝关节功能,用等速肌力训练仪于手术前后对双膝关节行被动角度重现试验,用关节位置感觉测定值（joint position sense,JPS）评定膝关节本体感觉恢复情况。结果 两组患者术后切口均Ⅰ期愈合。患者均获随访,试验组随访时间12～16个月,平均14.0个月;对照组12～15个月,平均14.5个月。术后12个月两组Lysholm评分及IKDC评分均较术前显著提高（P〈0.05）,两组间比较差异均无统计学意义（P〉0.05）。试验组内术后3、12个月患侧膝关节在屈曲15、45、75°位时JPS均显著低于术前（P〈0.05）,术后3、12个月间比较差异无统计学意义（P〉0.05）。对照组内术后3个月膝关节各屈曲角度时JPS与术前比较差异均无统计学意义（P〉0.05）,但术后12个月时JPS显著低于术前及术后3个月（P〈0.05）。两组间比较：术后3个月试验组膝关节各屈曲角度时JPS均显著低于对照组（P〈0.05）;术后12个月时两组间比较差异均无统计学意义（P〉0.05）。术后3、12个月,试验组膝关节各屈曲角度JPS健、患侧间比较差异均无统计学意义（P〉0.05）;对照组术后3个月患侧JPS显著高于健侧（P〈0.05）,术后12个月健、患侧间比较差异无统计学意义（P〉0.05）。结论 保留残端重建ACL有利于膝关节本体感觉的早期恢复。

Objective To compare the recovery of proprioception of the knee after the anterior cruciate ligament （ACL） reconstruction with remnant preservation or not. Methods Between January 2010 and October 2012, 40 patients with ACL rupture were divided into remnant preservation reconstruction group （trial group, n=20） and traditional reconstruction group （control group, n=20）. There was no significant difference in gender, age, disease duration, injury causes, preoperative Lysholm scores, and preoperative International Knee Documentation Committee （IKDC） scores between 2 groups （P 〉 0.05）. All the patients received ACL single-bundle reconstruction surgery with autologous hamstring tendon transplantation under arthroscope. After operation, the function of knee was assessed by Lysholm and IKDC scores and the proprioception was assessed by joint position sense （JPS） value which was evaluated by passive repeat angle test with isokinetic test system. Results All incisions healed by first intention in 2 groups. The patients were followed up 12-16 months （mean, 14.0 months） in trial group, and 12-15 months （mean, 14.5 months） in control group. At 12 months after operation, the Lysholm and IKDC scores were significantly increased when compared with preoperative scores （P 〈 0.05） in both groups, but no significant difference was found between 2 groups （P 〉 0.05）. At 3 months and 12 months after operation in trial group, the JPS values of operated knee at 15, 45, and 75~ of flexion were significantly lower than preoperative values （P 〈 0.05）, but no significant difference was found between at 3 months and at 12 months