膝关节置换修复退行性股骨髁间窝前交叉韧带撞击症的价值

Knee arthroplasty for treating degenerative femoral intercondylar fossa impingement syndrome

背景:传统上对退行性股骨髁间窝前交叉韧带撞击症采用非手术治疗,但是可造成交叉韧带功能的丧失,引起膝关节不稳等并发症。随着医学技术的发展,越来越多的观点主张对于韧带损伤及合并膝关节其他结构损伤应尽早手术治疗。目的:探讨膝关节置换对退行性股骨髁间窝前交叉韧带撞击症的修复效果,并与AO空心螺钉内固定对比。方法:纳入退行性股骨髁间窝前交叉韧带撞击症患者72例,根据随机抽签法分为治疗组与对照组,每组36例。对照组采用切开AO空心螺钉内固定治疗,治疗组采用膝关节置换治疗。治疗后7 d评定患者的修复效果;在治疗前与治疗后7 d根据Lysholm膝关节评分和国际膝关节文献委员会制定的膝关节评估表(IKDC)评分进行膝关节功能评定;治疗后对所有患者进行6个月的随访,调查并发症发生情况。结果与结论:所有患者均顺利完成手术。治疗后7 d治疗组的疗效优良率为94%,对照组为75%,治疗组明显高于对照组(P<0.05)。治疗后7 d治疗组的Lysholm评分明显高于治疗前,而IKDC评分明显低于治疗前,对比差异有显著性意义(P<0.05);同时治疗后7 d治疗组的Lysholm评分和IKDC评分均优于对照组,差异有显著性意义(P<0.05)。随访6个月,治疗组患者的切口感染、关节腔感染、关节疼痛、深静脉血栓等并发症发生率明显低于对照组(P<0.05)。提示膝关节置换治疗退行性股骨髁间窝前交叉韧带撞击症能提高近期疗效,有效恢复膝功能,同时减少置换后并发症的发生。

BACKGROUND： Traditionally, non-surgical treatment was used to treat degenerative femoral intercondylar fossa impingement syndrome, but it can cause function loss of cruciate ligament, or knee instability. With the development of medical technology, more and more views believed that ligament damage and combined with other knee structural damage should receive surgery as soon as possible. OBJECTIVE： To investigate the repair effect of knee arthroplasty for treating degenerative femoral intercondylar fossa impingement syndrome, and compare with AO cannulated screw fixation. METHODS： A total of 72 patients with degenerative femoral intercondylar fossa impingement syndrome were equally and randomly divided into treatment group and control group. Patients in the control group were treated with open AO cannulated screw fixation, and patients in the treatment group were subjected to knee arthroplasty. At 7 days after treatment, repair effect was evaluated. Before treatment and 7 days after treatment, knee function was assessed by using Lysholm knee Scoring Scale and the international knee documentation committee knee evaluation form. All patients were followed up for 6 months after treatment to investigate the occurrence of complications. RESULTS AND CONCLUSION： The surgery was successfully completed in all patients. At 7 days after treatment, the excellent and good rate was 94% in the treatment group and 75% in the control group. The excellent and good rate was significantly higher in the treatment group than in the control group（P〈0.05）. Lysholm scores were significantly greater, but the international knee documentation committee knee evaluation form scores were significantly lower at 7 days after treatment compared with that before treatment in the treatment group（P〈0.05）. Simultaneously, Lysholm scores and the international knee documentation committee knee evaluation form scores were significantly better in the treatment group than in the control group at 7 days after treatment（P〈0.05）. During 6-month follow-up, wound infection, intra-articular infection, joint pain, and deep vein thrombosis were significantly less in the treatment group than in the control group（P〈0.05）. These findings indicate that knee arthroplasty for degenerative femoral intercondylar fossa impingement syndrome can improve short-term efficacy, effectively restore knee function and reduce the incidence of postoperative complications.