胫骨残端长度对前交叉韧带重建术后本体觉恢复的影响

Effect of length of tibial stump on proprioceptive recovery after the reconstruction of anterior cruciate ligament

目的：研究保留韧带胫骨残端的长度对前交叉韧带重建术后膝关节本体觉恢复的影响。方法：自2011年3月至2011年12月于我院骨科就诊的42例前交叉韧带重建患者分为3组,每组14例。A组保留韧带胫骨残端长度15~20 mm,男8例,女6例,平均年龄（28.2±6.6）岁;B组保留韧带胫骨残端5~10 mm,男9例,女5例,平均年龄（27.9±6.4）岁;C组保留韧带胫骨残端小于2 mm,男9例,女5例,平均年龄（28.6±6.8）岁。治疗前后采用Lachman试验、前抽屉试验对稳定性进行评价,行Lysholm评分和Tegner评分评价关节功能,采用非负重位被动重复位置法对膝关节本体觉进行检测。结果：3组患者术后6个月Lachman试验、前抽屉试验均为阴性,12、18个月3组各1例前抽屉试验呈弱阳性。术后18个月Lysholm和Tegner评分均高于术前,而术后18个月3组间差异无统计学意义。屈曲20°和伸直80°、20°测试重复位置觉显示,3组在治疗前后差异无统计学意义。屈曲50°和伸直50°测试重复位置觉显示,A组和B组在术后6个月较治疗前好转,且明显优于C组;术后18个月3组差异无统计学意义。屈曲80°测试重复位置觉显示,A组和B组在术后12个月较治疗前好转,且明显优于C组;术后18个月3组差异无统计学意义。结论：保留韧带胫骨残端有助于前交叉韧带重建术后早期本体觉的恢复,残端长度以5~10 mm为宜。

Objective： To evaluate the effect of length of tibial stump on proprioceptive recovery after anterior cruciate lig- ament （ACL） reconstruction. Methods：From March 2011 to December 2011,42 patients with ACL tear were performed with reconstruction. The patients were divided randomly into three groups：group A, the patients with remained length of tibial stump ranging from 15 to 20 mm, including 8 males and 6 females, with an average age of （28.2±6.6） years old;group B, the patients with remained length of tibial stump ranging from 5 to 10 mm ,including 9 males and 5 females ,with an average age of （27.9±6.4） years old;group C, the patients with remained length of tibial stump less than 2 mm, including 9 males and 5 females, with an average age of （28.6±6.8） years old. The stability of knee were assessed by Lanchman test and anterior drawer test. The function of knee was assessed by Lysholm score and Tegner activity rating. The proprioceptive recovery was evaluated by as- sessing the passive reproduction of the angles with limb movement into flexion and extension in no weight bearing position. Re- sults： Lanehman test and anterior drawer test of all patients were negative at 6 months postoperatively, and there was one case of positive outcome in each group at 12 month and 18 month postoperatively. Lysholm score and Tegner activity score of all pa- tients at 18 month postoperatively were significantly better than that preoperatively, and there were no significant difference a- mong three groups at 18 month postoperatively. There were no significant difference in the production of the angles at flexion to 20° and extention to 80° and 20° among these groups before and after operation. The reproduction of the angles of group A and B at flexion to 50° and extention to 50° at 6 month postoperatively were significantly better than that of group A and B preoper- atively and that of group C at 6 month postoperatively, and there were no significant difference among three groups at 18 month postoperatively. The reproduction of the angles of group A and B at flexion to 80° at 12 month postoperatively were significantly better than that of group A and B preoperatively and that of group C at 12 month postoperatively ,and there were no significant difference among three groups at 18 month postoperatively. Conclusion：Preservation of tibial stump in ACL reconstruction has benefit in proprioceptive recovery at early stage postoperatively and the length of tibial stump should be reserved with a range from 5 to 10 mm.