异体肌腱双束重建治疗前交叉韧带断裂合并Segond骨折的效果观察

Treatment effect of anterior cruciate ligament rupture combined with Segond fracture after double-bundle ACL reconstruction with allogeneic tendon

目的探讨前交叉韧带断裂合并Segond骨折异体肌腱双束重建后膝关节旋转的稳定性。方法回顾性分析收治的36例前交叉韧带断裂患者,男25例,女11例,其中合并Segond骨折17例。所有患者均在关节镜下行前交叉韧带异体肌腱双束重建术,Segond骨折均未行处理。根据是否合并Segond骨折将研究对象分为2组,通过对比患者术前、术后及2组间KT-1000和膝关节功能Lysholm评分、国际膝关节文献委员会(IKDC)评分与轴移试验(Pivot shift test),评价其疗效。结果合并Segond骨折组术后KT-1000值与术前比较,差异有统计学意义(P<0.05);术后Lysholm评分与术前比较,差异有统计学意义(P<0.05);术后IKDC评分与术前比较,差异有统计学意义(P<0.05);术后Pivot shift test,0级1例,1级13例,2级2例,3级1例,较术前Pivot shift test,1级3例,2级2例,3级12例,差异有统计学意义(P<0.05)。未合并Segond骨折组术后KT-1000值与术前比较,差异有统计学意义(P<0.05);术后Lysholm评分与术前比较,差异有统计学意义(P<0.05);术后IKDC评分与术前比较,差异有统计学意义(P<0.05);术后Pivot shift test较术前差异有统计学意义(P<0.05)。而术后组间KT-1000、Lysholm评分、IKDC评分比较,差异无统计学意义(P>0.05);组间Pivot shift test比较,差异有统计学意义(P<0.05)。结论前交叉韧带断裂合并Segond骨折患者常规异体肌腱双束重建术后,膝关节旋转稳定性指标与未合并Segond骨折患者对比有明显差异,提示在重建前交叉韧带的同时,可能需要重视对Segond骨折及与相其相连的韧带的处理。

Objective To explore the rotational stability of the knee underwent double - bundle ACL reconstruction with allogeneic tendon after anterior cruciate ligament （ACL） rupture combined with Segond fracture. Methods A retrospective analysis of 36 patients with ACL rupture. They were 25 males and 11 females, and 17 patients were combined with Segond fractures. All patients underwent arthroscopic double - bundle ACL reconstruction with allogeneic tendon. All cases were divided into two groups according to whether it contains Segond fracture or not. Therapeutic effects between preoperation and postoperation and two groups were assessed with KT - 1000,IKDC score, Lysholm score and Pivot shift test. Results The KT- 1000,IKDC score,Lysholm score in the Segond fracture group were significantly improved after surgery （ P 〈 0. 05）. The Pivot shift test of preoperative were in 3 patients in grade 1,2 patients in grade 2 and 12 patients in grade 3. The Pivot shift test of postoperative were in one patients in grade 0,13 patients in grade 1,2 patients in grade 2,and one patients in grade 3. There was significant difference between preoperative with postoperative （P 〈0.05）. The KT - 1000,IKDC score,Lysholm score and Pivot shift test in the non - Seg- and fracture group were significantly improved after surgery （P 〈 0.05）. There was no significant difference in The KT- 1000,IKDC score and Lysholm score between two groups after operation （ P 〉 0. 05 ）, but significant statistical difference in Pivot shift test （P 〈 0. 05）. Condusion There is significant statistical difference in Pivot shift test （rotational stability） between two groups after undergoing double - bundle ACL reconstruction with allogeneic tendon because of ACL rupture combined with Segond fracture,it suggests that we should probably pay more attention to treatment of the Segond fracture and ALL while reconstruct ACL.