两种方法治疗膝前交叉韧带松弛的疗效比较

Comparison of two methods in the treatment of anterior cruciate ligament laxity

目的比较关节镜下前交叉韧带(ACL)重建联合射频挛缩与关节镜下单纯射频挛缩治疗ACL松弛的临床疗效。方法将43例ACL松弛患者根据治疗方法不同分为重建组(采用关节镜下ACL重建联合射频挛缩治疗,22例)和射频组(采用关节镜下单纯射频挛缩治疗,21例)。记录膝关节活动度,采用Lachman试验和轴移试验评估膝关节稳定性,采用Lysholm评分评价疗效。结果患者均获得随访,射频组随访时间8~24个月,重建组随访时间9~22个月。膝关节屈曲活动度射频组大于重建组(P<0.05)。Lysholm评分:两组术后3个月、末次随访均较术前显著提高(P<0.05);重建组末次随访高于术后3个月(P<0.05);射频组末次随访低于术后3个月(P<0.05);术后3个月和末次随访重建组均高于射频组(P<0.05)。结论与单纯射频挛缩相比,关节镜下ACL重建联合射频挛缩治疗ACL松弛可以增加韧带张力和韧性,有利于韧带后期修复,有效降低韧带松弛和断裂风险。

Objective To compare the clinical efficacy of arthroscopic reconstruction of anterior cruciate ligament(ACL)combined with radiofrequency shrinkage of preserved original ACL and arthroscopic ACL radiofrequency shrinkage in the treatment of ACL laxity.Methods Forty-three patients with ACL laxity were divided into the reconstruction group(22 cases were treated with arthroscopic ACL reconstruction and radiofrequency shrinkage of ACL preserved)and the radiofrequency group(21 cases were treated with arthroscopic radiofrequency shrinkage of preserved ACL).Knee rang of motion was recorded.Knee stability was evaluated by Lachman test and axial motion test,and efficacy was evaluated by Lysholm scoring system.Results All patients were followed up for 8~24 months in the radiofrequency group and 9~22 months in the reconstruction group.The knee flexion activity in the radiofrequency group was larger than that in reconstruction group(P<0.05).Lysholm scores:at 3 months after surgery and the last follow-up,both groups were significantly increased than the preoperation(P<0.05),which was higher at the last follow-up in the reconstruction group than that at 3 months after surgery(P<0.05),was lower at the last follow-up in the radiofrequency group than that at 3 months after surgery(P<0.05),and were higher at the 3 months and last follow-up after surgery in the reconstruction group than those in the radiofrequency group(P<0.05).Conclusions Compared with bipolar radiofrequency shrinkage alone,ACL reconstruction combined with radiofrequency shrinkage in the treatment of ACL laxity have the advantages of increasing ligament tension and toughness,which are conducive to the later repair of ligament,thus effectively reduce the risk of ligament laxity and fracture.