腘肌腱再张力化手术和重建术治疗急性膝关节后外旋转不稳定的临床疗效

The comparison of clinical outcomes of popliteal tendon recess and reconstruction technique

目的探讨腘肌腱再张力化手术和腘肌腱重建术治疗急性膝关节后外旋转不稳定的临床疗效。方法2012年1月至2017年1月行手术治疗并有2年以上随访和麻醉下体格检查结果的急性膝关节后外旋转不稳定患者54例。男30例,女24例;年龄(34.5±7.4)岁(范围20~45岁)。Fanelli分型A型31例、B型17例、C型6例。行腘肌腱再张力化手术28例、腘肌腱重建术26例。比较手术前后腘肌腱再张力化组与腘肌腱重建组的Lysholm评分、Tegner评分、国际膝关节文献委员会(International Knee Documentation Committee,IKDC)评分、内固定取出术中麻醉下拨号试验侧侧差值、后方及内翻应力试验侧侧差值,以及在内固定取出时二次关节镜探查的外侧沟通过试验结果。结果腘肌腱重建组随访时间(30.2±4.9)个月,腘肌腱再张力化组(32.2±9.9)个月。末次随访时,腘肌腱重建组Lysholm评分为(70.1±15.5)分,再张力化组为(70.0±10.2)分,两组差异无统计学意义(t=0.089,P=0.926);腘肌腱重建组Tegner评分为3(2,5)分[M(P25,P75)],再张力化组为2(1,4)分,两组差异无统计学意义(U=395.522,P=0.156);腘肌腱重建组IKDC评分为(74.8±19.3)分,再张力化组为(71.2±17.6)分,两组差异无统计学意义(t=0.381,P=0.722)。内固定取出术中麻醉下拨号试验侧侧差值分别为腘肌腱重建组1.5°±4.2°、再张力化组1.1°±4.0°,差异无统计学意义(t=0.586,P=0.565);腘肌腱重建组后方应力侧侧差值为(4.1±3.4)mm,再张力化组为(4.7±2.6)mm,两组差异无统计学意义(t=0.918,P=0.345);腘肌腱重建组内翻应力试验侧侧差值为(4.0±1.7)mm,再张力化组为(3.8±1.9)mm,两组差异无统计学意义(t=0.208,P=0.820)。两组均无外侧沟通过试验阳性患者。结论对膝关节后外旋转不稳定患者,腘肌腱再张力化手术和腘肌腱重建术均可显著改善患者的症状和功能,两种术式早期临床疗效接近。

Objective To compare the objective and subjective clinical outcomes of recess procedure versus popliteal tendon reconstruction in patients with posterolateral corner injury.Methods From January 2012 to January 2017,patients who were eligible for inclusion in this study if they 1)had acute posterolateral rotational instability(PLRI)and were treated surgically in our institution,2)were followed for a minimum of 2 years with examination under anesthesia results.The mean age was 34.5±7.4 years(range 20-45 years).According to Fanelli's classification,there were 31 type A,17 type B and 6 type C cases.There were 26 patients in reconstruction group and 28 patients in recess group.Outcomes included subjective scoring systems(Lysholm score,Tegner score and International Knee Documentation Committee(IKDC)subjective score),knee stability examinations(the side-to-side difference(SSD)of tibial external rotation angle by dial test,posterior and varus stress radiograph)and second-look arthroscopic lateral gutter drive-through test during hardware removal operation.Results The mean follow-up duration was 30.2±4.9 months in reconstruction group and 32.2±9.9 months in recess group.At the final follow-up,there were no significant differences in Lysholm scores(reconstruction group:70.1±15.5,recess group:70.0±10.2;t=0.089,P=0.926),Tegner scores(reconstruction group:3(2,5),recess group:2(1,4);U=395.522,P=0.156),or IKDC subjective scores(reconstruction group:74.8±19.3,recess group:71.2±17.6;t=0.381,P=0.722)between the groups.No significant difference in SSD on posterior stress radiography(reconstruction group:4.1±3.4 mm,recess group:4.7±2.6 mm;t=0.918,P=0.345)or medial stress radiography(reconstruction group:4.0±1.7 mm,recess group:3.8±1.9 mm;t=0.208,P=0.820)was observed.There was no significant difference on SSD of dial test(reconstruction group:1.5°±4.2°,recess group:1.1°±4.0°,t=0.586,P=0.565).No positive lateral gutter drive-through test was observed in all groups.Conclusion Both recess procedure and popliteal tendon reconstructions significantly improve the knee stability and subjective outcomes of patients with PLRI.In a comparison with popliteal tendon reconstruction,the recess procedure has similar subjective and objective clinical outcomes.