前交叉韧带部分损伤后关节镜下保留残束重建与单束重建的对比研究

A retrospective trial of arthroscopic reconstruction with residual- bundle reserved versus single- bundle reconstruction for treatment of anterior cruciate ligament partial injury

目的：比较前交叉韧带部分损伤后关节镜下保留残束重建与单束重建的临床疗效。方法：回顾性分析73例前交叉韧带部分损伤患者的病例资料,其中关节镜下保留残束重建31例,单束重建42例。男47例,女26例。年龄18~51岁,中位数29岁。左膝39例,右膝34例。受伤至手术时间4 d至17个月,中位数1个月。分别比较术前及术后12个月2组患者的国际膝关节文献委员会（international knee documentation committee,IKDC）评分、Tegner膝关节运动评分和Lysholm膝关节功能评分,并比较术后12个月2组患者于屈膝30°和屈膝90°时双膝胫骨前移距离差值。结果：1IKDC评分。术前及术后12个月单束重建组和保留残束重建组患者IKDC评分比较,组间差异均无统计学意义[（48.23±24.21）分,（38.26±18.35）分,t=0.752,P=0.426;（91.12±8.75）分,（94.12±7.23）分,t=0.845,P=0.513];术后12个月2组患者IKDC评分均高于术前（t=0.423,P=0.001;t=0.579,P=0.004）。2Tegner膝关节运动评分。术前及术后12个月2组患者Tegner膝关节运动评分比较,组间差异均无统计学意义[（52.45±28.97）分,（47.24±27.89）分,t=0.491,P=0.501;（94.21±5.51）分,（95.61±2.98）分,t=0.780,P=0.146];术后12个月2组患者Tegner膝关节运动评分均高于术前（t=0.213,P=0.000;t=0.458,P=0.007）。3Lysholm膝关节功能评分。术前及术后12个月2组患者Lysholm膝关节功能评分比较,组间差异均无统计学意义[（3.06±2.31）分,（2.76±2.68）分,t=0.813,P=0.079;（7.15±1.70）分,（7.45±1.72）分,t=0.851,P=0.124];术后12个月2组患者Lysholm膝关节功能评分均高于术前（t=0.741,P=0.006;t=0.193,P=0.000）。4双膝胫骨前移距离差值。术后12个月屈膝30°（15磅、20磅、30磅）和屈膝90°（15磅、20磅、30磅）时单束重建组患者的双膝胫骨前移距离差值均大于保留残束重建组[（1.51±1.52）mm,（0.54±1.01）mm,t=0.127,P=0.013;（1.92±1.57）mm,（0.74±1.04）mm,t=0.226,P=0.001;（2.23±1.32）mm,（1.35±1.26）mm,t=0.121,P=0.012;（0.97±1.24）mm,（0.42±0.76）mm,t=0.452,P=0.021;（0.97±1.68）mm,（0.34±1.02）mm,t=0.521,P=0.016;（1.25±1.49）mm,（0.53±1.26）mm,t=0.530,P=0.012]。结论：关节镜下保留残束重建和单束重建修复ACL部分损伤,均能获得满意的膝关节功能,但是保留残束重建较单束重建能够提供更好的膝关节稳定性。

Objective：To compare the clinical curative effects of arthroscopic anterior cruciate ligament（ACL） reconstruction with re- sidual- bundle reserved versus single -bundle reconstruction for treatment of ACL partial injury. Methods：The medical records of 73 pa- tients with ACL partial injury who were treated with arthroscopic ACL reconstruction with residual -bundle reserved（ 31 ）and single -bun- dle reconstruction（42 ）were analyzed retrospectively. The patients consisted of 47 males and 26 females, and ranged in age from 18 to 51 years（ median = 29 yrs）, and ranged in disease course from 4 days to 17 months（ Median =1 month）. The ACL partial injury located in left knee for 39 patients and right knee for 34 patients. International knee documentation committee （IKDC） score, Tegner knee movement score and Lysholm knee functional score were compared between the two groups before the surgery and at 12 months after the surgery respective- ly, and the difference in antedisplacement distance between bilateral tibia were also compared between the two groups when the knee was bent into a angle of 30 and 90 degrees at 12 months after the surgery. Results ：There was no statistical difference in IKDC scores between the 2 groups before the surgery and at 12 months after the surgery（48.23 ＋/-24.21 vs 38.26 ＋/- 18.35 points,t =0. 752,P =0. 426;91.12 ＋/- 8.75 vs 94.12 ＋/- 7.23 points, t = 0. 845,P = 0.513 ）. The IKDC scores of the 2 groups were higher at 12 months after the sur- gery compared to pre- surgery（t = 0. 423 ,P = 0. 001 ;t = 0. 579 ,P = 0.004）. There was no statistical difference in Tegner knee movement scores between the 2 groups before the surgery and at 12 months after the surgery（52.45 ＋/-28.97 vs 47.24 ＋/-27.89 points,t =0. 491, P = 0. 501 ;94.21 ＋/-5.51 vs 95.61 ＋/-2.98 points ,t = 0. 780, P = 0. 146）. The Tegner knee movement scores of the 2 groups were high- er at 12 months after the surgery compared to pre -surgery （t = 0. 213, P = 0. 000;t = 0. 458, P = 0. 007 ）. There was no statistical difference in Lysholm knee functional scores between the 2 groups before the surgery and at 12 months after the surgery （3.06 ＋/-2.31 vs 2.76 ＋/- 2.68 points, t = 0. 813,P = 0. 079;7.15 ＋/- 1.70 vs 7.45 ＋/-1.72 points, t = 0. 851, P = 0. 124 ）. The Lysholm knee functional scores of the 2 groups were higher at 12 months after the surgery compared to pre - surgery （ t = 0. 741, P = 0. 006 ; t = 0. 193, P = 0. 000）. The differ- ence in antedisplacement distance between bilateral tibia were greater in single - bundle reconstruction group compared to residual - bundle reconstruction group when the knee was bent into a angle of 30 degrees（ 15,20 and 30 pounds） and 90 degrees（ 15,20 and 30 pounds） at 12 months after the surgery （ 1.51 ＋/- 1.52 vs 0.54 ＋/- 1.01 mm, t = 0. 127,P = 0. 013 ; 1.92 ＋/- 1.57 vs 0.74 ＋/- 1.04 ram, t = 0. 226, P=0. 001 ;2.23 ＋/-1.32 vs 1.35 ＋/- 1.26 mm,t =0. 121,P =0. 012;0.97 ＋/- 1.24 vs 0.42 ＋/-0.76 mm,t =0. 452,P =0. 021; 0.97 ＋/- 1.68 vs 0.34 ＋/- 1.02 mm ,t = 0. 521 ,P = 0. 016 ; 1.25 ＋/- 1.49 vs 0.53 ＋/- 1.26 mm, t = 0. 530, P = 0. 012 ）. Conclusion ： Satisfactory knee function can be obtained by arthroseopic ACL reconstruction with residual - bundle reserved or single - bundle reconstruc- tion in the treatment of ACL partial injury, while the former surpasses the latter in knee stability.