关节镜下可调节袢钢板全内技术重建前交叉韧带的临床疗效分析

Clinical effect of all-inside anterior cruciate ligament reconstruction with adjustable loop plate under arthroscopy

目的探讨关节镜下可调节袢钢板全内技术重建前交叉韧带(ACL)的临床疗效。方法回顾性分析2018年1月-2019年7月湖南省人民医院集团澧县人民医院21例ACL损伤患者的临床资料,均行关节镜下可调节袢全内技术ACL重建。其中,男13例,女8例,年龄41~56岁,平均46岁,Lachman试验Ⅲ度阳性伴软性终止点18例,Lachman试验Ⅱ度阳性伴硬性终止点3例。观察移植物粗细、术前及术后影像学、术前及术后Lachman试验情况,比较术后健侧与患侧屈膝活动度以及术前、术后半年及术后2年的国际膝关节文献委员会(IKDC)评分、Lysholm评分和Larson评分等指标,以综合评估临床疗效。结果21例患者随访时间24个月。术前Lachman试验Ⅲ度阳性伴软性终止点和LachmanⅡ度阳性伴硬性终止点的病例,术中均证实ACL完全或大部分断裂。术后半年Lachman试验阳性0例,阴性21例。术中所使用的移植物平均直径(8.59±0.44)mm,术后三维CT测量股骨粗骨道长度(21.66±2.51)mm,移植物进入股骨骨道长度(19.82±2.29)mm,胫骨粗骨道长度(19.67±1.02)mm,移植物进入胫骨骨道长度(17.69±1.26)mm。术后半年MRI显示:移植物固定牢靠,与骨道贴合良好,信号均匀。术后末次随访,健侧、患侧最大屈膝角度分别为(131.42±3.59)°和(130.71±3.64)°,两者比较,差异无统计学意义(P>0.05)。术后半年Lysholm评分、IKDC评分和Larson评分分别为(88.19±1.97)、(74.05±2.36)和(67.52±2.23)分,术后2年分别为(97.76±1.97)、(88.62±3.07)和(90.57±2.46)分,均较术前的(22.00±3.35)、(41.67±1.85)和(39.81±1.81)分明显提高,术后半年和术后2年分别与术前比较,差异均有统计学意义(P<0.05)。结论关节镜下可调节袢钢板全内技术重建ACL,肌腱利用率高,稳定性好,中远期膝关节功能恢复满意,疗效肯定。

Objective To investigate the clinical effect of all-inside anterior cruciate ligament reconstruction with adjustable loop plate under arthroscopy.Methods Clinical data of 21 patients with anterior cruciate ligament injury who underwent arthroscopic adjustable loop total internal technique for anterior cruciate ligament reconstruction were retrospectively analyzed from January 2018 to July 2019.There were 13 males and 8 females,with an average age of 46(41~56)years,Lachman testⅢdegree positive with soft stop point in 18 cases,LachmanⅡdegree positive with hard stop point in 3 cases.The therapeutic effect were evaluated by the tendon thickness,preoperative and postoperative imaging,Lachman test before and at the last follow-up,knee flexion between healthy side and affected side after operation,the International Knee Document Committee(IKDC)score,Lysholm score,and Larson score before operation,half year after operation and two years after operation.Results 21 patients were followed up for 24 months.In the cases of Lachman test wasⅢdegree positive with soft termination point andⅡdegree positive with hard termination point before operation,it was confirmed that the anterior cruciate ligament was completely or mostly fractured during operation.Positive in 0 cases and negative in 21 cases half a year after surgery.The mean diameter of the grafts used during the operation was(8.59±0.44)mm,the mean length of femoral coarse bone tunnel measured by CT was(21.66±2.51)mm,and the length of the graft into the femoral coarse bone tunnel was(19.82±2.29)mm,the length of tibial coarse bone tunnel was(19.67±1.02)mm,and the graft into the tunnel was(17.69±1.26)mm.Half a year after the operation,MRI showed that the graft was firmly fixed,fitted well with the bone tunnel,and the signal was uniform.The last postoperative follow-up of the maximum knee flexion angle of the healthy and affected side was(131.42±3.59)°and(130.71±3.64)°,respectively,with no statistical difference(P>0.05).The Lysholm,IKDC and Larson score were(88.19±1.97),(74.05±2.36)and(67.52±2.23)respectively at the half year postoperation,(97.76±1.97),(88.62±3.07)and(90.57±2.46)respectively after two years,compared with the preoperative score of(22.00±3.35),(41.67±1.85)and(39.81±1.81),they were significantly higher,six months after surgery and two years after surgery were compared with those before surgery,there were statistically significant differences(P<0.05).Conclusion All-inside technique with adjustable loop plate under arthroscopy is a good choice for anterior cruciate ligament reconstruction,with high tendon utilization rate,good stability,and satisfactory knee function recovery in the near future,the curative effect is certain.