应用LARS韧带重建术与保守治疗50岁以上膝关节慢性前向不稳定患者的效果比较

Comparasion of clinical outcomes of reconstruction by LARS and conservative treatment for patients older than 50 years with chronic forward instability of knee joint

目的比较50岁以上慢性膝关节前向不稳定患者应用LARS韧带重建术与保守治疗的疗效差异,以更好地指导临床治疗。方法回顾性分析2008年5月至2013年9月在中国医科大学附属盛京医院关节运动外科收治的40例50岁以上膝关节慢性前向不稳定患者的临床资料,根据治疗方法的不同并根据随访结果剔除不合条件者,分成保守治疗组(n=16)和LARS韧带重建术组(n=19)。所有患者随访时间为24个月,评价指标包括吕斯霍尔姆评分(Lysholm),国际膝关节文献委员会膝关节评估表(IKDC),泰格纳评分(Tegner),膝关节活动度(ROM),关节动度测量仪测量结果(Kneelax)以及凯尔格伦-劳伦斯(Kellgren-Lawrence)关节炎分级。结果保守治疗组治疗后随访24个月结束时膝关节功能评分显著高于治疗前[Lysholm治疗后(83.4±12.5)分、治疗前(69.6±10.4)分,t=-11.502,P=0.00;IKDC治疗后异常2例、治疗前异常10例,P=0.00;Tegner治疗后6(1,9)分、治疗前3(1,5)分,Z=-3.471,P=0.01)]。LARS韧带重建术组膝关节功能评分及Kneelax测量结果术后较术前有显著提高[(Lysholm治疗后(80.0±14.2)分、治疗前(68.7±9.6)分,t=-7.875,P=0.00;IKDC治疗后异常2例、治疗前异常13例,P=0.00;Tegener治疗后8(1,9)分、治疗前3(1,5)分,Z=-3.879,P=0.00;Kneelax治疗后(1.5±0.8)mm、治疗前(4.2±0.8)mm,t=9.955,P=0.00)]。24个月随访结束时,LARS韧带重建术组Kneelax测量结果及Tegner评分显著高于保守治疗组(Z=6.109,P=0.00;Z=2.672,P=0.01)。结论与保守治疗相比,对于50岁以上慢性膝关节前向不稳定患者进行LARS韧带重建术更有利于膝关节的稳定性及功能的恢复。

Objective To compare the outcomes between conservative treatment and reconstruction with LARS in patients over 50 years old with chronic forward instability of knee joint.Methods Forty patients with chronic forward instability of knee joint from May,2005 to September,2013 in Shengjing Hospital of China Medical University were included in this study and were divided into conservative treatment group(16 cases) and LARS group(19 cases) besides that were ineligible according to different treatment methods.All patients were followed up for two years.The evaluation indicators included Lysholm,IKDC,Tegner,ROM,Kneelax and Kellgren-Lawrence rating.Results At the end of two-year follow-up,the knee joint function score of conservative treatment group was significantly higher than that before treatment (Lysholm score after treatment (83.4± 12.5) points,before treatment (69.6 ± 10.4) points,t =-11.502,P =0.00;IKDC after treatment,abnormal 2 cases,and before treatment,abnormal 10 cases,P =0.00;Tegner after treatment 6 (1,9) points,before treatment 3 (1,5) points,Z =-3.471,P =0.01).The knee joint function score and Kneelax measurement in the LARS ligament reconstruction group were significantly improved after operation(Lysholm score after treatment (80.0±14.2) points,before treatment (68.7±9.6) points,t =-7.875,P =0.00;IKDC score after treatment,abnormal 2 cases,and before treatment,abnormal 13 cases,P =0.00;Tegener score after treatment 8 (1,9) points,before treatment 3 (1,5) points,Z =-3.879,P=0.00;Kneelax score after treatment (1.5 ± 0.8) mm,before treatment (4.2 ± 0.8) mm,t =9.955,P =0.00).At the end of two-year follow-up,kneelax and Tegner scores in LARS ligament reconstruction group were significantly higher than those in conservative treatment group (Z =6.109,P=0.00;Z =2.672,P =0.01).Conclusion Compared with conservative treatment,LARS ligament reconstruction is more conducive to the stability and functional recovery of knee joint in patients over 50 years old with chronic anterior instability of knee joint.