关节镜下袖套状保留残端与不保留残端重建前交叉韧带的疗效比较

Comparison effect of cuff-shape preserving ligament stump and non-preserving stump for anterior cruciate ligament reconstruction under arthroscopy

目的比较关节镜下袖套状保留残端与不保留残端重建前交叉韧带的疗效。方法将60例ShermanⅠ型前交叉韧带损伤患者按照纳入先后次序随机分为观察组(采用关节镜下袖套状保留残端重建前交叉韧带治疗,30例)和对照组(采用不保留残端重建前交叉韧带治疗,30例)。采用Lachman试验、KT-1000侧侧差值及IKDC评分评估两组膝关节功能及稳定性,比较两组术后2年被动角度重现差值、骨隧道扩大程度及二次镜检下移植物滑膜覆盖情况。结果患者均获得随访,时间24~48个月。末次随访时,IKDC评分观察组明显高于对照组(P<0.05),KT-1000侧侧差值观察组明显低于对照组(P<0.05),Lanchman试验、被动角度重现差值两组比较差异均无统计学意义(P>0.05)。术后2年二次镜检下移植物滑膜覆盖情况优良率观察组明显高于对照组(P<0.05),股骨隧道及胫骨隧道扩大程度观察组明显低于对照组(P<0.05)。结论与不保留残端重建ACL技术相比,关节镜下袖套状保留残端重建ACL有利于腱-骨愈合,能够有效地改善膝关节功能,提高关节稳定性。

Objective To compare the effect of cuff-preserving stump and non-preserving stump reconstruction for anterior cruciate ligament(ACL)under arthroscopy.Methods The sixty patients who suffered from Sherman typeⅠACL injuries were randomly divided into two groups according to the inclusion order,with 30 patients in each group,the observation group was treated with arthroscopic cuff-preserving stump for reconstruction of the ACL,and the control was treated with arthroscopic cuff without preserving stump for reconstruction of the ACL.Lachman test,KT-1000lateral-lateral difference and IKDC score were used to evaluate the knee function and stability of the two groups.At 2years postoperation,the difference of passive angle recurrence,the expansion degree of bone tunnel and the synovial coverage situation of the graft under the second arthroscopic examination were compared between the two groups.Results All patients were followed up for 24~48 months.At the last follow-up,IKDC score in the observation group was significantly higher than that in the control group(P<0.05),and KT-1000 lateral-lateral difference of observation group was significantly lower than that in the control group(P<0.05);there were no statistical significances in Lanchman test and the difference of passive angle recurrence between two groups(P>0.05).At 2 years postoperation,the second arthroscopic examination showed that the excellent-good rate of graft synovial coverage in the observation group was significantly higher than that in the control group(P<0.05).The expansion degree of femoral tunnel and tibial tunnel in the observation group were significantly lower than those in the control group(P<0.05).Conclusions Compared with ACL reconstruction without stump preservation,arthroscopic cuff-shape stump-preserving for ACL reconstruction is beneficial to tendon-bone healing,and can effectively improve knee joint function and joint stability.