保留与切除残迹的前交叉韧带重建手术疗效分析

Comparison of remnant preservation vsremnant resection in arthroscopic anterior cruciate ligament reconstruction

目的探讨保留与切除残迹的前交叉韧带(anterior cruciate ligament,ACL)重建手术方法及疗效。方法 43例单侧ACL断裂患者,依据关节镜ACL重建术中是否切除ACL残迹分为保留组21例和切除组22例。记录2组术前及术后6个月双股部周径差值、关节活动度、Lysholm评分、术后国际膝关节文献委员会膝关节评估表(International Knee Documentation Committee,IKDC)评分,比较2组膝关节功能改善情况。结果术前保留组双股部周径差值((2.01±0.91)cm)、关节活动度((127.89±21.12)°)、Lysholm评分((57.12±8.91)分)与切除组((2.12±0.54)cm、(125.78±20.91)°、(56.98±9.12)分)比较差异无统计学意义(P>0.05);术后6个月,保留组双股部周径差值((0.89±0.94)cm)与切除组((1.01±0.51)cm)比较差异无统计学意义(P>0.05),关节活动度((149.78±6.91)°)、Lysholm评分((98.42±3.12)分)与切除组((142.89±11.12)°,(91.12±2.91)分)比较差异有统计学意义(P<0.05);术后保留组IKDC综合评级优良率(71.42%)高于切除组(59.09%)(P<0.05)。结论与关节镜下切除ACL残迹的ACL重建手术相比,术中保留ACL残迹更利于患者术后膝关节稳定和功能恢复。

Objective To compare the methods and surgical outcome of remnant preservation vs remnant resection in anterior cruciate ligament（ACL）reconstruction.Methods Forty-three patients with ACL rupture were divided into remnant preservation group（n=21）and remnant resection group（n=22）.The bi-femoral perimeter difference,range of joint motion,Lysholm score and postoperative International Knee Documentation Committee（IKDC）Knee Evaluation Form score were recorded before and 6 months after operation and the knee joint function improvement was compared between two groups.Results The bi-femoral perimeter difference,range of joint motion and Lysholm score showed no significant differences between remnant preservation group（（2.01±0.91）cm,（127.89±21.12）°,57.12±8.91）and remnant resection group（（2.12±0.54）cm,（125.78±20.91）°,56.98±9.12）（P〉0.05）before operation.The bi-femoral perimeter difference showed no significant difference between remnant preservation group（（0.89±0.94）cm）and remnant resection group（1.01±0.51）cm）（P〉0.05）,and there were significant differences in the range of joint motion and Lysholm score in remnant preservation group（（149.78±6.91）°,98.42±3.12）and remnant resection group（（142.89±11.12）°,91.12±2.91）6 months after operation（P〈0.05）.IKDC excellent rate was higher in remnant preservation group（71.42%）than that in remnant resection group（59.09%）（P 0.05）.Conclusion Remnant preservation can achieve a better outcome for maintaining stability of knee joint and improving knee joint function than remnant resection in arthroscopic anterior cruciate ligament reconstruction.