带线锚钉在前交叉韧带重建术中的应用效果及其对术后跪地痛的影响

The effect of suture anchors in anterior cruciate ligament reconstruction and its influence on kneeling pain

目的探究带线锚钉联合可吸收挤压螺钉在前交叉韧带重建术胫骨侧移植物固定中的应用效果。方法选择2015年3月至2017年5月首都医科大学附属北京朝阳医院骨科收治的因前交叉韧带断裂拟行关节镜下前交叉韧带同种异体肌腱重建术的76例患者,按照组间基线特征匹配的原则分为带线锚钉组(37例)及门形钉组(39例)。门形钉组股骨侧应用Endobutton固定,胫骨侧应用可吸收挤压螺钉联合门形钉固定。带线锚钉组股骨侧同样应用Endobutton固定,胫骨侧应用可吸收挤压螺钉联合带线锚钉固定。对术前、术后视觉模拟评分(visual analogue scale,VAS)、Lysholm评分、国际膝关节文献委员会膝关节评估表(International Knee Documentation Committee Knee Evaluation Form,IKDC)2000评分、膝关节活动度、是否发生术后跪地痛、前抽屉试验、Lachman试验、轴移试验等结果,以及年龄、体质量指数(body mass index,BMI)、手术时间、切口长度、术中出血量、住院费用等资料进行比较分析。结果术前2组患者前抽屉试验、Lachman试验、轴移试验均为阳性。术后24个月随访2组患者前抽屉试验、Lachman试验及轴移试验均为阴性。术后2组患者的Lysholm评分、IKDC评分、VAS评分以及膝关节活动度均较术前明显改善(P<0.05),但除VAS评分外,术前、术后2组患者的Lyshom评分、IKDC评分及膝关节活动度差异均无统计学意义(P>0.05)。术后6个月,门形钉组有8例出现跪地痛,其中5例进行了二次手术取出,而带线锚钉组仅有1例出现跪地痛,未再次手术。在跪地痛的发生率方面,两组差异有统计学意义(P<0.05)。结论带线锚钉联合可吸收挤压螺钉在关节镜下前交叉韧带重建术移植物胫骨侧固定方面可获得良好的临床效果,且中长期随访结果良好。特别是在术后跪地痛的发生率方面,可吸收挤压螺钉联合带线锚钉能够有效降低术后跪地痛的发生率,有显著的临床意义。

Objective To investigate the application of suture anchors(SA)combined with bio-absorbable interference screw(BIS)for graft fixation on tibia in anterior cruciate ligament(ACL)reconstruction.Methods Seventy-six patients who were diagnosed with ACL tear for ACL reconstruction were recruited from March 2015 to May 2017 at Beijing Chaoyang Hospital.According to the principle of baseline feature matching between groups,they were divided into two groups:SA group(37 cases)and Staple group(39 cases).During surgery,Endobutton was used for cortical femoral suspensory fixation in both groups.BIS with SA were used for tibial fixation in SA group.Respectively,BIS with staples were used for tibial fixation in Staple group.Lysholm,the International Knee Documentation Committee Knee Evaluation Form(IKDC)scores,visual analogue score(VAS),range of motion(ROM)and the incidence of kneeling pain were evaluated.Anterior drawer test,Lachman test and pivot shift test were recorded.Besides,the baseline information[age,body mass index(BMI),operation time,incision length,intraoperative hemorrhage and hospitalization expenses]was also collected.Baseline information was analyzed by ANOVA.Repetitive measurement and analysis of variance was used to analyze Lysholm score,IKDC score,VAS and ROM between both groups.Results At the last follow-up,all patients,were associated with negative anterior drawer,pivot shift and Lachman tests.Lysholm,IKDC scores and range of motion were significantly better than those before surgery(P<0.05),but there was no statistical difference between the two groups(P>0.05).Besides,at 6 months after surgery,kneeling pain was performed in 8 patients in Staple group,five patients of whom were performed secondary surgery for removing staples and debridement.Relatively,kneeling pain was preformed in 1 patients in SA group.This difference was statistically significant(P<0.05).Conclusion This study demonstrates that both tibial cortical fixation,either BIS with staples or BIS with SA,achieved similar satisfactory clinical outcomes for ACL reconstruction.Besides,lower incidence of kneeling pain was performed in BIS with SA.