关节镜下内减张技术重建膝关节前交叉韧带的临床研究

CLINICAL STUDY OF INTERNAL TENSION-RELIEVING TECHNIQUE IN ARTHROSCOPIC ASSISTED ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

目的探讨关节镜下内减张技术重建膝关节前交叉韧带(anterior cruciate ligament,ACL)的临床疗效及意义。方法 2011年3月-2014年9月,将收治的符合选择标准的51例ACL断裂患者随机分为两组,A组26例采用关节镜下结合内减张技术解剖单束重建ACL,B组25例采用关节镜下解剖单束重建ACL。两组患者性别、年龄、致伤原因、侧别、体质量指数、关节软骨损伤患者Outerbridge分级、受伤至手术时间及术前国际膝关节文献委员会(IKDC)评分、Lysholm评分、KT-1000测量值等一般资料比较差异均无统计学意义(P>0.05),具有可比性。术后3、6、12个月定期随访,进行KT-1000测量膝关节前向稳定性,采用IKDC评分及Lysholm评分评价膝关节功能。结果两组患者术后切口均Ⅰ期愈合,均未发生关节内感染,无下肢深静脉血栓形成及血管神经损伤等并发症发生。所有患者均获12个月随访。均行二次关节镜检查,见韧带连续性良好、组织覆盖良好,重建韧带无再次断裂发生,膝关节活动度无受限;复查MRI提示韧带与骨隧道均愈合良好。术后3、6、12个月两组患者KT-1000测量值、IKDC评分及Lysholm评分均较术前显著改善(P<0.05),术后各时间点间差异均无统计学意义(P>0.05)。术后3、12个月两组间比较IKDC评分及Lysholm评分差异无统计学意义(P>0.05);术后6个月A组IKDC评分及Lysholm评分优于B组(P<0.05)。两组间比较KT-1000测量值除术后3个月差异无统计学意义(P>0.05)外,术后6、12个月A组均显著优于B组(P<0.05)。结论对ACL断裂患者行关节镜下重建手术时,采用内减张技术能够有效缓解重建韧带的牵张力,利于重建韧带的愈合及术后膝关节早期康复训练。

Objective To study the effectiveness of internal tension-relieving technique for arthroscopic assisted anterior cruciate ligament（ACL） reconstruction. Methods Between March 2011 and September 2014, 51 cases of complete ACL rupture were randomly divided into 2 groups. Arthroscopic assisted single-bundle ACL reconstruction combined with internal tension-relieving technique was performed in 26 cases（group A）, arthroscopic assisted single-bundle ACL reconstruction in 25 cases（group B）. There was no significant difference in gender, age, cause of injury, injured side, body mass index, Outerbridge classification of articular cartilage injury, disease duration, and the preoperative International Knee Documentation Committee（IKDC） score, Lysholm score, and KT-1000 test value between 2 groups（P〈0.05）. At 3, 6, and 12 months after operation, the KT-1000 was used to measure the anterior stability, and IKDC and Lysholm scores to evaluate the function of knee joint. Results Healing of incision by first intention was obtained in all patients of 2 groups, without complications of infection, deep vein thrombosis of lower extremity, and blood vessels and nerves injury. The patients were followed up 12 months after operation. All patients received second microscopic examination. The reconstructed ACL had good continuity and good coverage of synovial tissue. There was no re-rupture in any cases. The range of motion of the knee joint was close to normal. The MRI showed good healing of the ligament and the bone tunnel at 12 months after operation. KT-1000 test value, IKDC score, and Lysholm score at 3, 6, and 12 months after operation were significantly improved when compared with preoperative ones（P〈0.05）, but no significant difference was found among different time points after operation（P〈0.05）. There was no significant difference in IKDC score and Lysholm score between 2 groups at 3 and 12 months（P〈0.05）; but IKDC score and Lysholm score of group A were significantly higher than those of group B（P〈0.05） at 6 months. At diffenent time points after operation, the KT-1000 test values of group A were significantly lower than those of group B（P〈0.05） except the value at 3 months（P〈0.05）. Conclusion For patients with ACL rupture, using internal tension-relieving technique can effectively alleviate tension force of reconstructed ligament, which is beneficial to the healing of reconstructed ligament and early rehabilitation of the knee joint.