前交叉韧带重建术后轻度旋转不稳定对临床疗效的影响

The Effect of Mild Residual Rotational Instability after Anterior Cruciate Ligament Reconstruction

目的评估分析前交叉韧带(anterior cruciate ligamemt,ACL)重建术后中短期内残留轻度旋转不稳定患者的主客观临床指标,总结归纳残留轻度旋转不稳定对临床疗效和结果的影响。方法选择自2015年1月到2018年1月在我所进行ACL重建术的46例患者资料,随访时间2~5年,平均随访时间(31.3±7.6)个月。以最后一次随访中患膝轴移试验阳性(Ⅰ度)和轴移试验阴性的患者为研究对象,以轴移试验检查结果为分组依据。其中,22例轴移阳性(Ⅰ度)患者归入不稳定组,24例轴移阴性患者归入稳定组。比较两组间患者术后移植物磁共振信号强度、手术前后国际膝关节文献委员会(international knee documentation committee,IKDC)主观评分、Lysholm评分、Tegner评分是否存在显著性差异,并统计术后主观评分和移植物信号强度之间的相关性。结果稳定组术后移植物磁共振信号强度明显优于不稳定组(P<0.05)。两组患者手术前后的IKDC主观评分、Lysholm评分、Tegner评分均有显著性提高(P<0.05),两组术后各项评分之间比较,差异无统计学意义(P>0.05)。术后主观评分与移植物信号强度无相关性(P>0.05)。结论ACL单束重建术后残留轻度旋转不稳定在中短期内会导致移植物信号强度增加,可能影响ACL愈合,但是不会影响患者主观评分等临床疗效。

Objective To analyze the subjective and objective clinical outcomes of patients with mild residual rotational instability after anterior cruciate ligament(ACL)reconstruction in short-medium term,and summarize the affection of mild residual rotational instability on clinical outcomes.Methods A follow-up database regarding patients undergoing ACL reconstruction in National Institute of Sports Medicine from January 2015 to January 2018 were retrospectively reviewed.The follow-up time was 2~5 years,the mean follow-up was(31.3±7.6)months.Based on the results of pivot shift test in the last follow-up,a total of 22 patients with grade 1 pivot shift test were included in the residual rotational instability group,24 patients with negative pivot shift test were included in the stability group.The differences of MRI signal intensity and subjective scores(IKDC subjective score,Lysholm score,Tegner score)before and after operation were compared between the two groups.The correlation between subjective scores and signal intensity of grafts was statistically analyzed.Results MRI signal intensity of the stability group was significantly better than residual rotational instability group.The IKDC subjective score,Lysholm score and Tegner score of the two groups were significantly improved more than 2 years after operation,but there was no significant difference between the two groups in the postoperation.There was no correlation between subjective scores and signal intensity of graft.Conclusion Mild residual rotational instability after ACL reconstruction will not affect the clinical outcomes of patients in short-medium term,but it will lead to the increase of signal intensity of graft on MRI,which may affect ACL graft healing.