小切口腘肌腱再张力化手术和关节镜下腘肌腱重建术治疗A型膝关节后外旋转不稳定的疗效对比研究

The Comparison of Clinical Outcomes of Minimally Invasive PT Recess Procedure versus Arthroscopic Popliteal Tendon Reconstruction in Patients with Type A Posterolateral Rotational Instability

目的:比较小切口腘肌腱再张力化手术和关节镜下腘肌腱重建术治疗A型膝关节后外侧旋转不稳定的临床疗效。方法:从2012年3月至2018年8月,满足下列要求的患者入选本研究:(1)在我院行小切口腘肌腱再张力化手术或关节镜下腘肌腱重建术的A型后外旋转不稳定患者;(2)最少2年随访,并有麻醉下查体及二次关节镜探查结果。小切口腘肌腱再张力化手术组为A组,关节镜下腘肌腱重建术组为B组。评估Lysholm评分、Tegner评分以及IKDC主观评分,拨号试验侧侧差值、应力像下胫骨后移以及外侧沟通过试验阳性率的组内和组间变化。结果:本研究A组患者40例,平均随访时间34.9±9.2个月,B组患者38例,平均随访33.7±3.6个月。末次随访时,两组患者的主客观评估指标均较术前获得了显著改善。组间比较显示,两组的Lysholm评分、Tegner评分以及IKDC主观评分均无显著差异。客观评估方面,拨号试验侧侧差值为A组2.8±2.9,B组2.4±2.6,应力像下胫骨后移A组4.4±3.4 mm,B组4.4±3.2 mm,无显著差异(P=0.988),外侧沟通过试验阳性率A组5.0%(2/40),B组2.6%(1/38),无显著性差异(P=0.964)。结论:小切口腘肌腱再张力化手术和关节镜下腘肌腱重建术治疗A型膝关节后外旋转不稳定均可取得满意的效果,且二者的疗效无显著差异。

Objectives To compare the clinical outcome of minimally invasive popliteal tendon(PT)recess procedure versus arthroscopic PT reconstruction for patients with type-A posterolateral rotational instability(PLRI). Methods Between March 2012 and August 2018,patients who were eligible for inclusion in this study if they(1) had type-A PLRI according to Fanelli’s classification undergoing PT recess procedure or arthroscopic PT reconstruction,(2) were followed for a minimum of 2 years with examinations under anesthesia(EUA) and second-time arthroscopic check. Patients who underwent PT recess procedure were designated as Group A,while patients who underwent arthroscopic PT reconstruction were labelled as Group B. The intra-and inter-group Lysholm scores,Tegner scores,IKDC subjective scores,side-to-side difference in the dial test,posterior tibial translation under the stress radiography and lateral gutter driver through(LGDT) test positive rate were evaluated. Results A total of40 eligible patients in group A with an average follow-up time of 34.9 ± 9.2 months and 38 in group B with a mean follow-up time of 33.7 ± 3.6 months were included. At the last follow-up,significant improvement was observed in both the subjective and objective measurements compared with before the operation. At the final follow-up,there were no significant inter-group differences in Lysholm scores,Tegner scores,or IKDC subjective scores. No significant difference was observed in side-to-side difference in the dial test(Group A: 2.8 ± 2.9,Group B: 2.4 ± 2.6),posterior tibial translation under stress radiography(Group A: 4.4 ± 3.4 mm,Group B: 4.4 ± 3.2 mm,P=0.988) or LGDT test positive rate(Group A: 2/40,5.0%,Group B: 1/38,2.6%,P=0.964). Conclusion There was no significant difference in clinical outcome between minimally invasive PT recess procedure versus arthroscopic PT reconstruction in the treatment of patients with type-A posterolateral rotational instability(PLRI),as both have satisfying outcomes.