保留残端或剩余束支并骨膜包绕肌腱重建前交叉韧带的临床研究

Anterior cruciate ligament reconstruction using ligment-remnant/residue stump preserving with tendon wrapped by periosteum technique

目的 进行关节镜下保留残端或剩余束支并骨膜包绕自体肌腱重建前交叉韧带（ACL）的临床研究,探寻ACL重建术后移植肌腱与骨隧道愈合的有效方法.方法 随机选取2010年7月～2013年6月共89例有韧带残端存留的ACL损伤患者入选本研究组,将患者随机分为实验组和对照组,实验组46例,对照组43例.分别进行关节镜下前交叉韧带重建手术,实验组予以保留前交叉韧带残端及剩余束支并骨膜包绕,对照组予以清理残端无骨膜包绕.术后随访12～29个月,对两组患者的轴移试验、Lachman试验、IKDC分级、KT-1000评分、Lysholm评分结果进行比较,并进行二次关节镜探查移植物滑膜覆盖情况.结果 实验组轴移试验、Lachman试验和IKDC分级的阴性率均高于对照组,实验组的KT-1000评分和Lysholm评分均高于对照组,差异有统计学意义（P＜0.05或P＜0.01）.两组患者滑膜覆盖分型构成差异有统计学意义（P＜0.01）.实验组滑膜覆盖良好率高于对照组,差异有统计学意义（P＜0.05）.结论 保留交叉韧带残端重建ACL,有助于移植肌腱再血管化及爬行替代,有利于维持膝关节稳定性.

Objective To study arthroscopic anterior cruciate ligament （ACL）reconstruction using lig ment--remnant /residue stump preserving with autologous tendon wrapped by periosteum technique for developing effective methods for grafted tendon--bone tunnel healing after ACL reconstruction. Methods Eighty --nine patients diagnosed with ligament stump remaining ACL injuries from July 2010 to June 2013 were enrolled in the study. The patients were randomly assigned to an experimental group （ n = 46） and a control group （ n =43）. The arthroscopic ACL reconstruction for the two groups was performed respectively. The ex- perimental group had ACL ligament--remnant/residue stump preserving with tendon wrapped by periosteum, and the control group had debridement of the remnant without periosteum wrapping. A 12-29 month followed --up was done after ACL reconstruction. The pivot shift test, Lachman test, IKDC evaluation, KT--1000 arthrometer and Lysholm score scale were done and the results were compared between groups. The grafts with synovial covering were assessed by using second ly arthroscopy. Results The experimental group had higher negative rates in the pivot shift test and the Lachman test and the IKDC evaluation, and also had higher KT-- 1000 scores and Lysholm scores, compared to the control group, there were was statistically significant differences （ P 〈0.05 or P 〈0.01）. Statistically significant difference was found in synovial covering formation between the two groups （ P〈0.01）. The experimental group had better synovial covering, compared to the control group, there was statistically significant difference （ P 〈0.05）. Conclusion ACL reconstruction with ACL ligment--remnant/residue stump preserving can be contributed to the revascularization of grafted tendon and creeping substitution. It is beneficial for maintaining the stability of knee joint.