佩戴功能支具未影响自体腘绳肌腱重建前交叉韧带短期临床疗效与移植物成熟度

Function Brace Did Not Influence Clinical Outcomes and Graft Maturity after anterior Cruciate Ligament Reconstruction Using Hamstring Autograft:A Short-Term Follow-up Study

目的:探究应用功能支具对采用自体腘绳肌腱重建前交叉韧带术后短期临床疗效和移植物成熟度的影响。方法:华山医院运动医学科2014年1月至2015年1月间前交叉韧带重建病例按纳入标准和排除标准进行筛选,根据术后是否使用功能支具分为支具组和非支具组。纳入114例,主观评价87例(87/114,76.3%),客观评价75例(75/114,65.8%)。支具组35例,平均佩戴13.6周,平均年龄26.7岁,男/女为27/8,平均随访25.9个月;非支具组52例,平均年龄27.5岁,男/女为37/15,平均随访25.2个月。主观评价包括Tegner活动评分、Marx活动评级量表、Lysholm膝关节评分量表、KOOS膝关节损伤与骨关节炎评分。客观评价包括膝关节查体、等速肌力测试和术侧膝核磁共振扫描。移植物成熟度以信噪比表示。结果:末次随访时,支具组和非支具组相比,Tegner评分为5.6±1.1和5.3±1.2;Marx评分为10.4±2.7和9.8±2.9;Lysholm评分为93.1±6.9和92.3±5.5;KOOS评分中,疼痛为94.9±5.1和94.0±5.7;症状为90.8±7.9和92.1±5.6;日常生活能力为98.1±2.6和97.5±4.0;功能为83.6±12.6和84.1±7.8;生活质量为80.1±8.3和80.5±11.2;IKDC评分为A或B级分别为27例(93.1%)和43例(95.7%);患侧H/Q在60°下为53.0±7.9和55.0±11.9;180°下为62.0±8.3和65.0±11.2;患侧伸膝标准峰值力矩在60°为2.5±0.4 Nm/kg和2.4±0.6 Nm/kg;180°为1.6±0.2 Nm/kg和1.5±0.2 Nm/kg;伸膝峰值力矩的肢体对称指数在60°下为81.2±17.5和82.4±13.0;在180°下为84.4±18.2和83.8±11.5;信噪比为5.9±10.3和6.2±8.3。上述结果在两组间差异均无统计学意义。结论:佩戴功能支具未影响自体腘绳肌腱重建ACL术后短期临床疗效及移植物成熟度。

Objectives To investigate the influence of using function brace(FB)on the short-term clinical outcomes and graft maturity after the anterior cruciate ligament(ACL)reconstruction using hamstring autografts.Methods The patients undergoing the ACL reconstruction at the Sports Medicine Department of Shanghai Huashan Hospital between January 1 st 2014 and January 1 st 2015 were selected and randomly divided into a function brace(FB)group and a non-function brace(NFB)group according to using the FB or not after the ACL reconstruction.A total of 114 cases were included with 87(87/114,76.3%)finishing the subjective evaluation and 75(75/114,65.8%)completing the objective evaluation.In the FB group,there were 35 cases with the mean age of 26.7 years old,male/female of 27/8,mean follow-up period of 25.9 months,while in the NFB group,there were 52 cases with the mean age of 27.5 years old,male/female of 37/15,mean follow-up period of 25.2 months.The subjective evaluation consisted of the Tegner Activity Score(TAS),the Marx Activity Rating Score(MARS),the Lysholm Knee Scoring Scale(LKSS),and the Knee Injury and Osteoarthritis Outcome Score(KOOS),while the objective evaluation covered the physical knee exam,isokinetic muscle strength test,and the MRI scan of the ipsilateral knee.The graft maturity was evaluated using the signal/noise quotient(SNQ).P value less than 0.05 was considered as significant statistically.Results The average TAS,MARS and LKSS of the FB group and the NFB group,were 5.6±1.1 and 5.3±1.2,10.4±2.7 and 9.8±2.9 as well as 93.1±6.9 and 92.3±5.5,while the mean pain,symptom,activity of daily life,function and life quality scores of the KOOS were 94.9±5.1 and 94.0±5.7,90.8±7.9 and 92.1±5.6,98.1±2.6 and 97.5±4.0,83.6±12.6 and 84.1±7.8 as well as80.1±8.3 and 80.5±11.2.Of the two groups,27 cases(93.1%)and 43 cases(95.7%)were classified as the IKDC grade A or grade B.Moreover,the average ipsilateral 60°H/Q,180°H/Q,ipsilateral 60°standardized peak torque(SPT),180°SPT,limb symmetry index(LSI)of the 60°extensor torque peak(EPT),180°EPT and SNQ of the FB and NFE group were 53.0±7.9 and 55.0±11.9,62.0±8.3 and 65.0±11.2,2.5±0.4 Nm/kg and 2.4±0.6 Nm/kg,1.6±0.2 Nm/kg and 1.5±0.2 Nm/kg,81.2±17.5 and 82.4±13.0,84.4±18.2 and 83.8±11.5 as well as 5.9±10.3 and6.2±8.3.No significant difference was observed in the above measurements between the two groups.Conclusion The using of FB does not influence the clinical outcomes and graft maturity in short term after ACL reconstruction using hamstring autografts.