关节镜下前交叉韧带重建保留残端的临床效果分析

Clinical analysis of saved stump of arthroscopic anterior cruciate ligament reconstruction

目的对比在镜下重建前交叉韧带是否保留残端的两种方法,分析术后膝关节功能及本体感觉恢复的临床效果。方法将即将手术的50例前交叉韧带重建手术的患者随机分成观察组（n=25）和对照组（n=25）。观察组在进行前交叉韧带重建中采用保留残端在鞘内重建;对照组在进行前交叉韧带重建中清除残端。均选择自体腘绳肌腱作为移植物。术前、术后及定期随访患者进行膝关节功能（Lysholm、IKDC）的评估、膝关节的（Lachman试验、轴移试验、KT-2000测量）客观稳定性的评价及本体感觉功能的测定。结果患者随访12~24个月,平均18个月。术后3、6、9和12个月及末次随访：Lysholm评分对比两组比较差异有显著性（P〈0.05）;IKDC评分对比两组比较差异有显著性（P〈0.05）;两组比较测量侧-侧（患侧及健侧KT-2000）的差值〈3 mm,差异有显著性（P〈0.05）;本体感觉的角度重复试验差异有显著性（P〈0.05）。术后两组Lachman试验、轴移试验对比差异无显著性（P〉0.05）。结论在镜下重建前交叉韧带保留残端术后膝关节的功能、稳定性及本体感觉恢复好,可以获得满意的临床效果。

[ Objective ] To compare two methods of retained anterior cruciate ligament reconstruction under arthroscopy, analyze the clinical effect of functional recovery of knee joint proprioception postoperative. [ Methods ] 50 cases of anterior cruciate ligament reconstruction operation were randomly divided into observation group （n =25） and control group （n =25）. The observation group was retained stump reconstruction in sheath in anterior cruciate ligament reconstruction; in the control group removed stump in anterior cruciate ligament reconstruction. Autologous hamstring tendon was selected as graft. Before operation and regular follow-up of patients, the improvement of function of the knee joint was evaluated by Lysholm, IKDC, Lachman, pivot shift test, KT-2000 and proprioceptive. [Results] Patients were followed up for 12-24 months, average 18 months. After 3, 6, 9, 12 months and the last follow-up： Scores were compared between the two groups, there were statistically significant differences in Lysholm （P〈0.05）. Scores was statistically significant differences in IKDC between the two groups （P 〈0.05）. The two group of comparison measurement side-to-side （ipsilateral and contrala-teral KT-2 000） difference was smaller than 3mm（P 〈0.05）. There were significant differences of proprioceptive angle repeat tests （P 〈0.05）. There was no statistical significance between two groups by Lachman test, pivot shift test （P 〉0.05）. [ Conclusion ] In the arthroscopy anterior cruciate ligament reconstruction, retained stump postoperative knee function, stability and proprioception recovered well and can obtain satisfactory clinical effect.