摘要
目的研究关节镜下直接止点解剖重建膝前交叉韧带(ACL)的疗效。方法选取首都医科大学友谊医院(北京市平谷区医院)2017年1-12月收治的行ACL重建手术的患者52例为研究对象,根据随机序列软件及患者选择结果分为两组。试验组27例,采取关节镜下直接止点解剖重建手术治疗。对照组25例,采用传统定位重建手术。分别于术后1个月、3个月、6个月、1年随访,通过术后影像学及主客观指标进行疗效评价。结果52例患者平均随访11.5个月,无伤口感染、关节感染、关节不稳、打软腿等症状,膝部疼痛改善,关节活动恢复满意。试验组Lysholm评分为(94.80±4.18)分,对照组为(91.02±1.96)分,差异有统计学意义(t=2.674,P<0.05);拉赫曼(Lachman)试验和KT-1000差值均较术前明显改善(均P<0.01),两组差异均无统计学意义(均P>0.05),但试验组轴移试验优于对照组,差异有统计学意义(P<0.05);试验组ACL角为(51.52±5.18)°,对照组为(55.86±2.45)°,差异有统计学意义(P<0.05);参考Cameron等改良Lysholm评分分级标准,试验组优24例,良2例,可1例,优良率为96.3%,对照组优18例,良5例,可2例,优良率为92.0%,差异有统计学意义(P<0.05)。结论直接止点解剖重建能够很好的恢复膝关节前向及旋转稳定性,是一种安全可行的、疗效满意的解剖重建ACL的治疗方法。
Objective To explore the operating methods and clinical effects of arthroscopic anatomical anterior cruciate ligament(ACL) reconstruction with direct insertion technique versus traditional method. Methods From January 2017 to December 2017, totally 52 patients who accepted ACL reconstruction and met the inclusion and exclusion criteria in Beijing Friendship Hospital of Capital Medical University were enrolled in this retrospective study. They were divided into two groups by random sequence software and patients′ selection results. The observation group(27 cases) received direct insertion technique, and the control group(25 cases) received traditional method. At postoperative 1 month, 3 months, 6 months, 1 year, the clinical effect was evaluated by imaging index, subjective and objective indicators. Results All 52 patients were available for follow up with an average of 11.5 months. No postoperative complications such as infection, joint instability and soft legs, with a satisfied recovery of range of motion, pain relieved significantly. The Lysholm score of the observation group was (94.80±4.18)points, which was significantly higher than (91.02±1.96)points of the control group (t=2.674, P<0.05). Lachman test and KT-1000 were improved significantly compared with those before operation(all P<0.01), while there was no statistically significant difference between the two groups(all P>0.05), but the pivot-test of the observation group was better than that of the control group, the difference was statistically significant (P<0.05). The ACL angle of the observation group was (51.52±5.18)°, which was significantly lower than (55.86±2.45)° of the control group (P<0.05). According to modified Lysholm scores classification, in the observation group, 24 cases were excellent, 2 cases were good, 1 case was fair, and the excellent and good rate was 96.3%. In control group, 18 cases were excellent, 5 cases were good, 2 cases were fair, and the excellent and good rate was 92.0%. The difference in the excellent and good rate between the two groups was statistically significant(P<0.05). Conclusion Direct insertion anatomical reconstruction is a safe and effective technique for reconstruction of ACL. It can restore the stability of ACL and rotation of knee joint.
作者
王海明
杨春雨
陈小光
范江涛
陈辉
周自广
Wang Haiming;Yang Chunyu;Chen Xiaoguang;Fan Jiangtao;Chen Hui;Zhou Ziguang(Department of Orthopaedic Surgery,Beijing Friendship Hospital of Capital Medical University,Pinggu Hospital,Beijing 101200,China)
出处
《中国基层医药》
CAS
2019年第7期844-847,共4页
Chinese Journal of Primary Medicine and Pharmacy
基金
北京市平谷区卫计委科研项目(pgwjw2017-05).
关键词
膝损伤
前交叉韧带
关节镜检查
解剖重建
关节不稳定性
疗效比较研究
Knee injuries
Anterior cruciate ligament
Arthroscopy
Anatomic reconstruction
Joint instability
Comparative effectiveness research