前交叉韧带断裂和重建的临床流行病学分析

Clinical epidemiological study on anterior cruciate ligament rupture and reconstruction

背景:前交叉韧带解剖重建是治疗前交叉韧带断裂的主要方法。目前针对前交叉韧带重建,从组织胚胎、解剖结构和生物力学,到重建材料、操作技术和重建后康复都进行了全面细致的研究,但缺乏前交叉韧带断裂和重建的临床流行病学资料。目的:分析前交叉韧带断裂和重建的临床流行病学特点,为预防和治疗前交叉韧带断裂提供指导。方法:统计了前交叉韧带断裂重建患者352例,对患者的年龄、性别、受伤原因、受伤机制、就诊时间和前交叉韧带断裂后对半月板和关节软骨的影响,以及手术过程中的发现情况、手术方式和重建材料等进行分析。结果与结论:(1)前交叉韧带断裂多发生于男性年轻人,左膝多于右膝;(2)男性患者多发生于篮球、足球和意外伤,女性患者多发生于意外伤、羽毛球和滑雪伤,损伤机制以膝关节内旋外翻伤多见;(3)手术时间以前交叉韧带断裂伤1-3个月多见,常伴有半月板和关节软骨损伤。外侧半月板损伤发生率相对稳定,内侧半月板损伤在前交叉韧带断裂超过半年后明显增多。关节软骨损伤以髌骨软骨损伤为主,超过1年,内侧髁软骨损伤显著增加;(4)韧带重建方式以解剖单束重建为主,骨道定位可参考住院医师嵴和束间嵴,重建材料多为自体半腱股薄肌肌腱;(5)结果提示,前交叉韧带断裂应早期进行前交叉韧带的解剖重建,恢复膝关节的稳定性,防止内侧半月板和股骨内侧髁软骨的继发损伤。

BACKGROUND：Anterior cruciate ligament（ACL） reconstruction is the primary treatment method for ACL rupture.Currently,studies on ACL reconstruction involve histology and embryology,anatomical structure,biomechanics,reconstruction materials,operating technology,and rehabilitation after reconstruction.However,clinical epidemiological studies describing ACL rupture and reconstruction remain scarce.OBJECTIVE：To analyze the clinical epidemiological characteristics of ACL rupture and reconstruction to provide guidance for prevention and treatment of ACL rupture.METHODS：Data of 352 patients for age,gender,cause and mechanism of injury,treatment time,and the impact of ACL rupture on menisci and articular cartilage were gathered.Meanwhile,the events during surgery,operation methods and reconstruction materials were analyzed.RESULTS AND CONCLUSION：ACL rupture mostly occurred in young men,and happened more often to the left knee;male patients got hurt in basketball,football and accidental injuries,while female patients got hurt in the accidental injuries,badminton and skiing injuries,internal rotation with valgus stress accounted for the predominant injury mechanism.The ACL reconstruction was mostly performed within 1-3 months after ACL rupture,often accompanied by meniscal and articular cartilage damage.Lateral meniscus injury incidence was relatively stable,medial meniscus injury incidence increased significantly over the half year after ACL rupture.Most articular cartilage injury occurred to patellar cartilage.A significant increase in medial condylar cartilage damage over 1 year after ACL rupture was often observed.Anatomic single-bundle ACL reconstruction was the primary surgical approach,the resident ridge and the lateral bifurcate ridge could be used to position bone tunnel and autogenous semitendinosus and gracilis tendon were the most commonly used reconstruction materials.Our results indicate that anatomic ACL reconstruction should be performed as early as possible in restore knee joint stability and prevent secondary injury of the medial meniscus and cartilage of medial femoral condyle.