ACL重建、半腱肌转位悬吊治疗急性ACL合并MCL损伤疗效分析

The Effect of Suspension of Reflexed Semitendinosus Combined with Anterior Cruciate Ligament Reconstruction in Treatment of Medial Collateral Ligament and Anterior Cruciate Ligament Rupture

目的探讨前交叉韧带(anterior cruciate ligament,ACL)重建、半腱肌转位悬吊治疗急性ACL合并膝内侧副韧带(medial collateral ligament,MCL)损伤的疗效。方法对2013年1月至2018年1月我院手术治疗的急性ACL断裂并MCL损伤的45例患者进行前瞻性研究,按入院顺序分为两组,A组21例为锚钉缝合组,B组24例为半腱肌肌腱转位悬吊组。A组男17例,女4例;年龄20~55岁,平均(32.4±15.6)岁。B组男18例,女6例;年龄18~52岁,平均(31.6±16.3)岁。分别在术后3、6、12、24个月对患者随访评估,记录膝关节内侧关节间隙宽度、Lysholm评分、国际膝关节文献委员会(international knee documentation committee,IKDC)评分。结果40例纳入最终分析,A组18例,B组22例,随访时间24~32个月,平均(27.6±4.3)个月。术前A组内侧关节间隙宽度、Lysholm评分、IKDC评分分别为(10.3±2.2)mm、(35.5±3.7)分、(35.8±4.3)分,B组分别为(10.8±1.4)mm、(34.4±2.7)分、(39.5±6.4)分。术后2年,A组的随访各指标为(3.5±0.2)mm、(91.6±2.1)分、(83.0±3.4)分,B组为(1.9±0.1)mm、(93.9±1.3)分、(85.0±3.6)分。术后两组各期随访指标较术前改善,差异有统计学意义(P<0.05);术后组间内侧间隙宽度比较,A组各同期指标大于B组,差异有统计学意义(P<0.05),余各同期指标两组间差异无统计学意义。结论ACL重建、半腱肌转位悬吊治疗急性ACL合并MCL损伤,创伤小、操作简单,可以获得较好的膝关节稳定性和功能评分。

Objective To explore the early optimal surgical procedure for injuries of anterior cruciate ligament(ACL)and medial collateral ligament(MCL).Methods In this perspective study,45 patients with ACL and MCL rupture admitted to our hospital from Janurary 2013 to Janurary 2018 were divided into two groups according to the order of admission.21 patients underwent ACL construction combined with suspension of transposable semitendinosus surgery in group A.24 patients underwent ACL reconstruction combined with suture anchor surgery in group B.In group A,there were 17 males and 4 females.The average age was(32.4±15.6)years,ranging from 20 to 55 years.In the B group,there were 18 males and 6 females.The average age was(31.6±16.3)years,ranging from 18 to 52 years.Patients were assessed in 3 months,6 months,12 months and 24months after surgery,and the knee medial joint space width,the Lysholm knee function score and the international knee documentation committee knee evaluation form(IKDC)score were recorded.Results 40 patients were analyzed at last,including 18 patients in group A,22 patients in group B.All the patients were followed up for 24 to 32 months,with an average of(27.6±4.3)months.Before operation,the knee medial joint space width,the Lysholm score and the IKDC score were(10.3±2.2)mm,(35.5±3.7),(35.8±4.3)in group A and(10.8±1.4)mm,(34.4±2.7),(39.5±6.4)in group B.After 24 months,the knee medial joint space width,the Lysholm score and the IKDC score of the group A were,(3.5±0.2)mm,(91.6±2.1),(83.0±3.4),and were(1.9±0.1)mm,(93.9±1.3),(85.0±3.6)in group B.The levels of the medial joint space width,Lysholm scores,and IKDC scores were significantly improved compared with those before operation(P<0.05),however,and the width of postoperative medial space in group A was significantly greater than that in group B(P<0.05),however there was no statistically significant difference between the two groups in the remaining indicators of the same period.Conclusion For patients with ACL and MCL rupture,the ACL reconstruction combined with suspension of transposable semitendinosus operation has less trauma,simple operation,good knee stability and functiong scroes.