不同移植物重建治疗军事训练致后交叉韧带损伤的疗效比较

Comparison of the effects of different grafts on the reconstruction of posterior cruciate ligament injuries caused by military training

目的比较关节镜下使用自体半腱肌/股薄肌肌腱(ST/G肌腱)和LARS人工韧带重建治疗军事训练所致的膝关节后交叉韧带(posterior cruciate ligament,PCL)损伤的疗效。方法回顾性分析我院2011年5月至2015年12月收治的47例PCL损伤病例的临床资料,将采用自体ST/G肌腱重建PCL的23例病人纳入ST/G肌腱组,采用LARS人工韧带重建PCL的24例纳入LARS韧带组。采用患肢屈伸活动度(ROM)、国际膝关节评分委员会(IKDC)评分及Lysholm评分评价膝关节功能;采用KT-2000试验评估PCL的松弛程度。结果 ST/G肌腱组术后6个月的IKDC评分、Lysholm评分分别为(78.4±7.5)分、(77.5±5.8)分,均低于LARS韧带组的(83.0±6.9)分、(88.3±5.2)分,差异均有统计学意义(P均<0.05);但两组术后1年的IKDC评分、Lysholm评分比较,差异均无统计学意义(P均>0.05)。LARS韧带组KT-2000试验结果:健侧、患侧在15、20、25磅外力作用时,胫骨后移值差异均无统计学意义;但ST/G肌腱组在25磅外力作用时,胫骨后移明显增大,差异有统计学意义(P=0.04)。结论与ST/G肌腱相比,采用LARS人工韧带重建PCL能尽早恢复膝关节的功能,更适合高强度训练导致的军事训练伤或运动损伤。

Objective To compare the effects of the reconstruction of posterior cruciate ligament(PCL)caused by military training using autologous ST/G tendon and LARS artificial ligament under arthroscopy.Methods Total of 47 patients with PCL injuries caused by military training in our hospital from May 2011 to December 2015 were retrospectively analyzed.They were divided into ST/G group and LARS group according to different grafts.The range of motion,International Knee Documentation Committee(IKDC),Lysholm scores and KT-2000 were used to evaluate the knee function and ligamentum laxity.Results The IKDC score and Lysholm score in ST/G group at 6-month follow-up were 78.4±7.5 and 77.5±5.8,and 83.0±6.9 and 88.3±5.2 in the LARS group,with statistically significant difference(P<0.05 for all),but there was no statistically significant difference between two groups at the last follow-up(P>0.05).Conclusion Compared with the ST/G tendon,the reconstruction of PCL with LARS artificial ligament can restore the active function of the knee as early as possible,which is more suitable for the military training or exercise injury caused by high intensity training.