前交叉韧带重建术中保留与不保留残段的近期临床疗效倾向评分对比研究

The propensity score comparative study of the early clinical efficacy of anterior cruciate ligament reconstruction with and without remnant preservation

目的比较保留前交叉韧带(ACL)残段ACL重建术与不保留残段ACL重建术的近期临床疗效。方法回顾性分析2013年3月至2016年3月收治的84例符合纳入标准的已行关节镜下ACL自体腘绳肌肌腱重建术的ACL损伤患者,采用倾向性评分匹配的方法分为保留残段重建组和不保留残段重建组(各34例)。保残组接受关节镜下保留ACL残段自体腘绳肌肌腱重建ACL手术,非保残组接受常规的关节镜下清除ACL残段自体腘绳肌肌腱重建ACL手术。分别统计两组患者术后近期的Lysholm评分、IKDC评分、KT-1000测量值、被动活动察觉阈值(TTDPM)结果,用t检验对比两组结果之间的差异。结果匹配前,两组患者性别、年龄、损伤原因、受伤至手术时间等一般临床资料差异有统计学意义(P<0.05);匹配后,两组一般临床资料差异无统计学意义(P>0.05)。保残组与非保残组术后分别随访6-16个月(平均10.59±3.13)和6-14个月(平均10.71±2.41),术后Lysholm评分分别为(91.37±3.51)分和(90.84±2.68)分;术后IKDC评分分别为(90.26±3.73)分和(87.99±4.99)分;术后KT-1000测量值分别为(1.96±0.26)mm和(2.05±0.24)mm,以上指标比较差异无统计学意义(P>0.05);TTDPM值分别为(1.87°±0.25°)和(2.04°±0.24°),差异有统计学意义(P=0.013)。结论保留ACL残段重建ACL较不保留ACL残段重建ACL,术后功能评分和关节稳定性方面无明显差别,但在本体感觉恢复方面具有优势。

Objective To compare the clinical efficacy of remnant-preserving anterior cruciate ligament(ACL)reconstruction and standard ACL reconstruction with allograft.Methods A retrospective study performed in 84 eligible patients with ACL rupture who were assigned into 2 groups from March 2013 to March 2016.34cases who received ACL reconstruction with remnant preservation technique(remnant-preserve group)and 34cases who received standard ACL reconstruction(the standard group)were selected using the propensity score matching method.Two groups of patients with preoperative data differences were not statistically significant(P>0.05).The Lysholm score,IKDC score,KT-1000,passive activities perceived threshold(TTDPM)results were evaluated in postoperative.Results Among all patients,there were significant differences in gender,age,the causes of injury and the times of injury to operations between the two groups(P<0.05);After propensity score matching,patient distributions were closely balanced.There was no significant difference in clinicopathologic characteristics between the two groups(P>0.05).Remnant-preserve group and standard group were followed up for 6-16 months(mean10.59±3.13)and 6-14 months(mean 10.71±2.41),the postoperative Lysholm score(91.37±3.51)points and(90.84±2.68)points,the IKDC scores were(90.26±3.73)points and(87.99±4.99)points,the KT-1000 measured values were(1.96±0.26)mm and(2.05±0.24)mm,above all indicators showed no statistically significant(P>0.05).TTDPM values were(1.87°±0.25°)and(2.04°±0.24°),the difference was statistically significant(P=0.013).Conclusion Remnant-preserving anterior cruciate ligament(ACL)reconstruction compared with the standard ACL reconstruction surgery,postoperative functional scores,no significant difference in joint stability,proprioception recovery there are differences.