膝关节镜下滑膜清理联合保留残端前韧带重建术治疗陈旧性前交叉韧带断裂的临床观察

Clinical Observation on Treatment of Old Anterior Cruciate Ligament Fracture with Synovial Clearance and Retention of Anterior Ligament Reconstruction under Knee Arthroscopy

目的:探究膝关节镜下滑膜清理术联合保留残端前交叉韧带(ACL)重建术治疗陈旧性ACL断裂的临床效果。方法:回顾性分析76例陈旧性ACL患者临床资料,所有患者均实施膝关节镜下滑膜清理术,联合保留残端ACL重建术治疗者纳入观察组(n=42),联合清除残端ACL重建术治疗者纳入对照组(n=34)。比较术前及术后3个月、6个月、12个月时,两组患者膝关节稳定性、膝关节功能(Lysholm膝关节评分)、生活受影响程度[2000国际膝关节文献委员会(IKDC)主观评分]变化,分析术后12个月时两组治疗效果及12个月内并发症发生情况差异。结果:术后3个月、6个月、12个月时,两组患肢膝关节胫前位移松弛度均较术前有显著下降,且观察组明显低于同期对照组(P均<0.05);两组Lysholm膝关节评分及IKDC主观评分均较术前有显著提升,且观察组明显高于同期对照组(P均<0.05)。术后12个月时,观察组患者治疗有效率明显优于对照组(P <0.05)。术后12个月内,两组各项并发症发生率比较均无统计学意义(P均>0.05)。结论:膝关节镜下滑膜清理+保留残端ACL重建术治疗效果较为突出,且相较于清除残端术式并未增加并发症发生风险,有利于患肢尽早建立膝关节稳定性及其功能恢复机制。

Objective:To explore the clinical effect of arthroscopic synovial debridement combined with anterior cruciate ligament(ACL)reconstruction for old ACL rupture.Methods:The clinical data of 76 patients with old ACL were retrospectively analyzed.All patients were given knee arthroscopic synovectomy,and patients who were combined with ACL reconstruction with remnant preservation were included in observation group(n=42),and patients who were combined with ACL reconstruction with remnant removal were included in control group(n=34).The knee stability,knee function(Lysholm knee joint score)and life affected degree[2000 International Knee Documentation Committee(IKDC)Subjective score]were compared between the two groups before operation and at 3 months,6 months and 12 months after operation.The treatment effects at 12 months after treatment and the complications within 12 months were analyzed in the two groups.Results:At 3 months,6 months and 12 months after operation,the anterior displacement relaxation of knee joints in the two groups was significantly lower than that before operation,and the index in observation group was significantly lower than that in control group(all P<0.05).The Lysholm knee score and the IKDC subjective score were significantly improved compared with those before operation,and the scores in observation group were significantly higher than those in control group(all P<0.05).At 12 months after operation,the effective rate of treatment in observation group was significantly better than that in control group(P<0.05).There was no significant difference in the incidence rate of complications between the two groups within 12 months after operation(all P>0.05).Conclusions:Knee arthroscopic synovectom+ACL reconstruction with remnant preservation has prominent treatment effects,and it does not increase the risk of complications compared with the method of remnant removal,and it is beneficial to the early development of mechanism of knee stability and function recovery.