膝关节镜下自体肌腱与Lars人工韧带移植重建膝关节前交叉韧带临床疗效比较

Comparison of clinical efficacy of arthroscopic reconstruction of anterior cruciate ligament of the knee by autologous tendon transplantation and Lars artificial ligament transplantation

目的比较膝关节镜下自体肌腱与Lars人工韧带移植重建膝关节前交叉韧带的临床早期康复疗效。方法选取北部战区总医院自2017年5月至2019年6月收治的318例膝关节前交叉韧带重建患者为研究对象。根据韧带选材不同,将患者分为自体肌腱组(n=162)和Lars韧带组(n=156)。比较两组患者的术后站立行走时间,术后24、72 h的视觉模拟评分法(VAS)评分,以及术后1周、1个月的美国纽约特种外科医院(HSS)膝关节评分。结果所有患者均接受6~24个月的随访,平均随访时间为11个月,且患者术后均无明显的膝关节肿胀和疼痛、神经和血管损伤、关节内感染等。自体肌腱组和Lars韧带组术后站立行走时间分别为(4.57±1.29)d和(3.01±1.39)d,两组比较,差异无统计学意义(P>0.05)。Lars韧带组术后24、72 h的VAS评分分别为(3.10±1.52)分、(2.10±1.12)分,均低于自体肌腱组的(6.57±1.91)分、(4.39±1.22)分,两组比较,差异有统计学意义(P<0.05)。Lars韧带组术后1周、1个月的HSS膝关节评分分别为(61.10±1.52)分、(81.10±1.81)分,均高于自体肌腱组的(55.57±2.01)分、(69.93±1.82)分,两组比较,差异有统计学意义(P<0.05)。结论与自体肌腱比较,Lars人工韧带移植重建膝关节前交叉韧带术后疼痛感更轻,膝关节功能恢复更满意。

Objective To compare the early clinical rehabilitation effect of arthroscopic reconstruction of the anterior cruciate ligament of the knee with the transplantation of autologous tendon and Lars artificial ligament.Methods A retrospective study was performed on 318 cases of patients with anterior cruciate ligament reconstruction who were admitted from May 2017 to June 2019.According to the different materials of ligaments,the patients were divided into the autologous tendon group(n=162)and the Lars ligament group(n=156).Postoperative standing and walking time,visual analogue scale(VAS)scores at 24 hours and 72 hours,and knee joint scores at hospital for special surgery(HSS)1 week and 1 month after surgery were compared between the two groups.Results All patients were followed up for 6 to 24 months,with an average follow-up time of 11 months,and there was no obvious knee swelling and pain,nerve and vascular injury,or intra-articular infection.The postoperative standing and walking time in the autologous tendon group and the Lars ligament group were(4.57±1.29)days and(3.01±1.39)days,respectively,with no statistically significant difference(P>0.05).VAS scores of the Lars ligament group at 24 and 72 hours after surgery were(3.10±1.52)points and(2.10±1.12)points,respectively,which were lower than those of the autologous tendon group(6.57±1.91)points and(4.39±1.22)points,with statistically significant differences(P<0.05).The HSS knee scores of the Lars ligament group one week and one month after surgery were(61.10±1.52)points and(81.10±1.81)points,respectively,which were higher than those of the autologous tendon group(55.57±2.01)points and(69.93±1.82)points,P<0.05.Conclusion Compared with autologous tendon,Lars artificial ligament transplantation for reconstruction of anterior cruciate ligament of the knee has,less pain,and more satisfactory recovery of knee function.