韧带重建联合胫骨高位截骨治疗晚期前交叉韧带损伤

Anterior cruciate ligament reconstructions with or without high tibial osteotomy for the ligament tear at late stage

[目的]比较前交叉韧带重建联合或不联合胫骨高位截骨术治疗晚期前交叉韧带损伤的临床效果。[方法]回顾性分析2016年1月~2018年12月期间来本院治疗的陈旧性前交叉韧带损伤患者46例。其中,20例行前交叉韧带重建联合胫骨高位截骨术,26例行常规单纯前交叉韧带重建。比较两组患者围手术期、随访与影像资料。[结果]两组患者均顺利手术,术中均未发生血管、神经损伤,筋膜室综合症等严重并发症。联合组在手术时间、术中失血量、切口长度方面均显著大于常规组(P<0.05)。所有患者随访12个月以上,与术前相比,末次随访时两组ROM、HSS评分和Lysholm评分均显著增加(P<0.05),而VAS评分均显著减少(P<0.05)。末次随访时,联合组ROM、HSS评分、Lysholm评分和VAS评分均显著优于常规组(P<0.05)。影像方面,末次随访时,联合组机械轴偏离距显著小于常规组(P<0.05)、内侧股骨近端角显著大于常规组(P<0.05)、关节线匹配角显著小于常规组(P<0.05)。[结论]胫骨高位截骨术可显著改善交叉韧带重建治疗晚期前交叉韧带损伤的临床效果。

[Objective] To compare the clinical outcomes of anterior cruciate ligament reconstructions(ACLR) with or without high tibial osteotomy(HTO) for the ligament tear at late stage. [Methods] A retrospective study was conducted on 46 patients who underwent ACLR for the ligament tear at late stage in our hospital from January 2016 to December 2018. Of them, 20 patients had ACLR performed combined with HTO, while the remaining 26 patients had conventional ACLR without HTO. The perioperative, follow-up and imaging data were compared between the two groups. [Results] All patients had successful operation without injuries to nerves and blood vessels, as well as compartment syndrome. The combined group consumed significantly longer operation time, associated with significantly more blood loss and greater incision length than the conventional group(P<0.05). The follow-up period lasted for more than 12 months. The ROM, HSS and Lysholm scores significantly increased, whereas the VAS score significantly decreased in both groups at the latest follow-up compared with those before operation(P<0.05).At the latest follow-up, the combined group proved significantly superior to the conventional group regarding ROM, HSS,Lysholm and VAS scores(P<0.05). With respect to imaging evaluation, the combined group got significantly greater medial proximal tibia angle(MPTA), whereas significantly less mechanical axis deviation(MAD) and joint line congruence angle(JLCA) than the conventional group at the latest follow up(P<0.05). [Conclusion] The high tibial osteotomy does improve clinical outcomes of anterior cruciate ligament reconstruction for the ligament tear at late stage in this study.