膝关节前交叉韧带损伤患者的一站式个性化单束重建术治疗策略研究

Study on one-stop personalized single bundle reconstruction for patients with anterior cruciate ligament injury of knee joint

目的探讨膝关节前交叉韧带损伤患者的一站式个性化单束重建术治疗策略。方法前瞻性选取2019年1月至2020年6月北华大学附属医院收治的膝关节前交叉韧带损伤患者101例,按随机数字表法分为试验组(51例)和对照组(50例)。2组均根据术前精确测量其股骨骨性解剖参数及半月板损伤类型制定前交叉韧带单束解剖重建术方案,其中试验组采用股骨AM束附着点(即足印区直接止点区域)定位,对照组采用传统足印区中心定位。比较2组治疗前、末次随访时国际膝关节文献委员会膝关节评估表(IKDC)评分及膝关节Lysholm评分,并对比治疗前、末次随访时拉赫曼(Lachman)、前抽屉试验(ADT)及轴移试验(PST)结果,另比较KT-2000测量仪下胫骨前移度。结果2组末次随访时的IKDC评分、Lysholm评分均高于治疗前,试验组末次随访时的IKDC评分、Lysholm评分均高于对照组,差异均有统计学意义(P<0.05)。试验组及对照组末次随访时的Lachman试验、ADT试验、PST试验结果等级分布均优于治疗前,差异均有统计学意义(P<0.05),试验组末次随访时的Lachman试验、ADT试验、PST试验结果等级分布与对照组比较差异均无统计学意义(P>0.05)。2组末次随访时KT-2000测量屈膝30°及90°的胫骨前移度均小于治疗前,试验组末次随访时KT-2000测量屈膝30°及90°的胫骨前移度均小于对照组,差异均有统计学意义(P<0.05)。结论对膝关节前交叉韧带损伤患者在实施前交叉韧带重建术前精确测量其股骨骨性解剖参数及评估半月板损伤情况,并以此为指导,采用改良的股骨AM束附着点定位的单束解剖重建方案,术后可获得良好的膝关节稳定性,且在改善膝关节功能方面效果满意。

Objective To explore the one-stop personalized single bundle reconstruction for patients with anterior cruciate ligament injury of knee joint.Methods One hundred and one patients with anterior cruciate ligament injury of knee joint admitted Bei Hua University Hospital from January 2019 to June 2020 were selected,who were randomly divided into experimental group(51 cases)and control group(50 cases).The anterior cruciate ligament single bundle anatomical reconstruction programme of the both groups were made according to the preoperative accurate measurement of the femoral bone anatomical parameters and meniscus injury types,and the AM attachment point(direct stop area of footprints)of femoral am bundle was used to locate in the experimental group,while the center of traditional footprints was located in the control group.The International Knee Documentation Committee knee joint evaluation form(IKDC)score and the Lysholm score of knee were compared in the 2 groups before and after treatment,and the results of Lachman,anterior drawer test(ADT)and Pivot shift test(PST)before and after treatment were compared,and the anteversion of tibia under KT-2000 was also compared.Results The IKDC score and Lysholm score in the last follow-up of the two groups were higher than those before treatment,which in the last follow-up of the experimental group were higher than those in the control group,and the differences were statistically significant(P<0.05).There were significantly different in grade distribution of the results of Lachman test,ADT test and PST test in the experimental group and the control group before and at the last follow-up(P<0.05),but there was no significantly different in the results of Lachman test,ADT test and PST test in the experimental group at the last follow-up and the control group(P>0.05).The tibial anteversion of 30°and 90°flexion measured by KT-2000 in the two groups at the last follow-up were less than those before treatment,which in the experimental group at the last follow-up were less than those in the control group,and the differences were statistically significant(P<0.05).Conclusion To accurately measure the femoral bone anatomical parameters and assess of meniscus damage types of patients with anterior cruciate ligament injury before performing anterior cruciate ligament single bundle anatomical reconstruction to guide the the modified AM bundle attachment point of femur using in the operation,the good stability of knee joint can be obtained after operation,and the effect of improving knee joint function is satisfactory.