开放手术与关节镜辅助手术治疗膝关节脱位的疗效比较

Comparative study of open surgery and arthroscopic assisted surgery in management of knee dislocations

目的比较开放手术与关节镜辅助手术治疗膝关节脱位的临床疗效方法采用回顾性病例对照研究分析2013年5月至2019年9月兰州大学第二医院收治的80例膝关节脱位患者的临床资料,其中男59例,女21例;年龄18〜66岁[(42.5±11.6)岁]。49例行开放多韧带重建术(开放组),31例行关节镜辅助多韧带重建术(关节镜组)。记录并比较两组术后住院时间、并发症发生率、术后膝关节活动度(>0°、〉90°、〉120°)恢复时间及完全负重时间。比较两组末次随访时Lysholm评分、国际膝关节文献委员会(IKDC)主观评分、Tegner运动分级、健康调查简表(SF-36)评分、患者满意度、膝关节活动度。结果患者均获随访1.2-7.4年[(3.8±1.5)年]。两组术后住院时间、并发症发生率比较,差异均无统计学意义(P>0.05)。术后膝关节活动度恢复(>0°、>120°)时间、完全负重所需时间比较,差异均无统计学意义(P>0.05).开放组膝关节活动度恢复(>90°)时间为90(60,90)d,关节镜组为60(30,90)d(P<0.05).两组末次随访时Lysholm评分JKDC主观评分Jegner运动分级、SF-36评分、患者满意度比较,差异无统计学意义(P均〉0.05)。末次随访时开放组膝关节活动度为120°(90°,130°),关节镜组为135°(120°,140°)(P<0.05)。结论开放手术与关节镜辅助手术治疗膝关节脱位的远期效果相似,但关节镜辅助手术有利于术后早期功能锻炼,膝关节活动度更好。

Objective To compare the efficacy of open surgery and arthroscopic assisted surgery in treatment of knee dislocations.Methods A retrospective case-control study was conducted to analyze the clinical data of 80 patients with knee dislocations admitted to Second Hospital of Lanzhou University from May 2013 to September 2019,including 59 males and 21 females,aged 18-66 years[(42.5±11.6)years].Open multiple ligament reconstruction was performed in 49 patients(open group)and arthroscopic assisted multiple ligament reconstruction was performed in 31 patients(arthroscopic group).The postoperative hospitalization days,incidence of complications,time needed for recovery of knee range of motion(>0°,>90°,>120°),and time to complete weight-bearing were compared between the two groups.The Lysholm score,international knee documentation committee(IKDC)subjective knee form,Tegner activity level,score of the MOS item short-form health survey(SF-36),patient satisfaction and knee range of motion were compared between the two groups at the last follow-up.Results All the patients were followed up for 1.2-7.4 years[(3.8±1.5)years].There was no significant difference in postoperative hospitalization days or incidence of complications between the two groups(P>0.05).No significant difference was found in time needed for recovery of knee range of motion(>0°,>120°)or time to complete weight-bearing(P>0.05).The time needed for recovery of knee range of motion(>90°)was 90(60,90)days in open group and 60(30,90)days in arthroscopic group(P<0.05).At the last follow-up,there was no significant difference in Lysholm score,IKDC subjective score,Tegner activity level,SF-36 score,or patient satisfaction between the two groups(P>0.05).At the last follow-up,the knee range of motion was 120°(90°,130°)in open group and 135°(120°,140°)in arthroscopic group(P<0.05).Conclusion For treatment of knee dislocations,open surgery and arthroscopic assisted surgery have similar results in the long-term effect,while arthroscopic assisted surgery has benefits in early rehabilitation and ultimately better knee range of motion.