WALANT技术下前交叉韧带部分损伤缝合术的疗效研究

Effectiveness of partial anterior cruciate ligament suture repair with wide awake local anesthesia no tourniquet technique

目的探讨采用完全清醒局部麻醉无止血带(wide awake local anesthesia no tourniquet,WALANT)技术行前交叉韧带(anterior cruciate ligament,ACL)部分损伤缝合术的疗效。方法2017年7月—2019年7月,收治18例ACL部分损伤患者。男10例,女8例;年龄22~57岁,平均40.5岁。左膝5例,右膝13例。14例有明确外伤史或运动损伤史,4例无明显诱因。损伤至手术时间1~6个月,中位时间3个月。采用WALANT技术于关节镜下对部分损伤韧带进行缝合修复。记录手术时间、总住院时间以及术后住院时间。术后采用国际膝关节文献委员会(IKDC)评分和Lysholm评分评价膝关节功能,前抽屉试验和Lachman试验评价膝关节稳定性,使用李克特五点评分评价患者满意度。结果手术时间为30~100 min,平均64.2 min;总住院时间2~12 d,平均4.5 d;术后住院时间1~4 d,平均1.8 d。术后切口均Ⅰ期愈合,无手术相关并发症发生。患者均获随访,随访时间12~36个月,平均19.1个月。患者前抽屉试验及Lachman试验均为阴性,术后6、12个月Lysholm评分、IKDC评分显著高于术前,术后12个月高于术后6个月,差异均有统计学意义(P<0.05)。末次随访时,根据李克特五点评分评价患者满意度,获非常满意7例、比较满意10例、一般1例,总满意度为94.4%(17/18)。MRI复查示韧带张力良好。结论使用WALANT技术在关节镜下缝合修复ACL部分损伤能最大限度保留患者自身韧带组织,取得满意早期疗效。

Objective To investigate the effectiveness of partial anterior cruciate ligament(ACL)suture repair with wide awake local anesthesia no tourniquet(WALANT)technique.Methods Between July 2017 and July 2019,18 patients with partial ACL injury were admitted.There were 10 males and 8 females,with an average age of 40.5 years(range,22-57 years).There were 5 cases on the left knee and 13 cases on the right knee.Forteen cases had a clear history of trauma or sports injury,and 4 cases had no obvious cause.The time from injury to operation was 1-6 months(median,3 months).Partial ligament was sutured using WALANT technique under arthroscopy.The operation time,total hospital stay,and postoperative hospital stay were recorded.Lachman test and anterior drawer test were performed to evaluate the knee joint stability after treatment,and Lysholm and International Knee Documentation Committee(IKDC)scores were used to evaluate the knee function.Five-point Likert scaling were used to evaluate postoperative patient satisfaction.Results The operation time was 30-100 minutes(mean,64.2 minutes).The total hospital stay was 2-12 days(mean,4.5 days).Postoperative hospital stay was 1-4 days(mean,1.8 days).All incisions healed by first intention after operation,and no surgery-related complications occurred.All patients were followed up 12-36 months(mean,19.1 months).Lachman test and anterior drawer test were negative after operation.Lysholm score and IKDC score at 6 and 12 months after operation were significantly higher than those before operation,and at 12 months after operation were higher than those at 6 months after operation,the differences were significant(P<0.05).At last follow-up,according to five-point Likert scaling of patient satisfaction,7 cases were very satisfied,10 cases were relatively satisfied,and 1 case was general.The total patient satisfaction rate was 94.4%(17/18).MRI scan showed the good ligament tension.Conclusion Using WALANT technique to repair partial ACL injuries under arthroscopy can retain the patient’s own ligament tissue to the maximum extent and achieve satisfactory short-term effectiveness.