关节镜下三隧道重建术治疗膝关节前交叉韧带损伤患者的疗效分析

Curative effect analysis of arthroscopic three tunnel reconstruction foRanterioRcruciate ligament injury

目的:探究关节镜下三隧道重建术在膝关节前交叉韧带(ACL)损伤患者治疗中的应用价值。方法:选取某院2019年5月—2021年9月收治的118例膝关节ACL损伤患者为研究对象,采用随机数字表法分为2组,每组59例。对照组实施悬吊固定术,观察组实施关节镜下三隧道重建术。比较2组患者手术相关指标、术后3、7 d,疼痛程度(VAS评分)、术后3个月血清指标[骨桥蛋白(OPN)、骨桥蛋白配体(CD44)、骨钙素(BGP)、基质金属蛋白酶(MMP-1)]水平、膝关节功能评分[膝关节恢复情况(Lysolm评分)、膝关节稳定性(KSS评分)、膝关节活动情况(IDKC评分)]及膝关节活动优良率。结果:2组患者手术时间比较差异无统计学意义(P>0.05);观察组住院时间[(8.67±2.31)d]、负重开始时间[(36.25±5.77)d]均短于对照组[(12.74±2.88)d、(44.73±7.12)d](P<0.05)。术后3、7 d,观察组VAS评分分别为(3.59±0.73)分、(1.85±0.57)分,均低于对照组的(4.22±0.65)分、(3.12±0.61)分,差异有统计学意义(P<0.05)。术后3个月,观察组血清OPN[(8.42±2.26)μg/L]、CD44[(162.47±18.35)μg/L]、BGP[(6.24±1.77)μg/L]、MMP-1[(5.25±1.36)μg/L]水平均低于对照组[(13.36±2.37)μg/L、(216.54±20.33)μg/L、(7.59±1.74)μg/L、(6.52±1.47)μg/L](P<0.05);观察组Lysolm评分[(87.92±6.74)分]、KSS评分[(19.69±3.45)分]、IDKC评分[(89.95±7.36)分]均高于对照组[(80.37±6.59)分、(15.73±2.84)分、(81.57±6.94)分](P<0.05);观察组膝关节活动优良率(96.61%)高于对照组(86.44%),差异有统计学意义(P<0.05)。结论:关节镜下三隧道重建术治疗膝关节ACL损伤患者能缩短康复进程及早行负重功能训练开始时间,缓解疼痛,增加膝关节稳定性,提高膝关节活动能力。

Objective:To discuss the clinical application value of arthroscopic three tunnel reconstruction in the treatment of anterioRcruciate ligament(ACL)injury.Methods:118 patients with ACL injury were randomly divided into an observation group(n=59)and a control group(n=59).The control group was treated with suspension and fixation,while the observation group underwent arthroscopic three tunnel reconstruction.The two groups were compared in terms of operation-related indexes,pain intensity(VAS)3d~7d afteRoperation,serum indexes 3 months afteRoperation(OPN,CD44,BGP,MMP-1),knee joint function scores(Lysolm,KSS,IKDC)and excellent rate of knee joint activity.Results:There was no significant difference in the operation time between the two groups(P>0.05).Length of hospitalization[(8.67±2.31)d]and weight-bearing walking time[(36.25±5.77)d]in the observation group was significantly shorteRoRearlieRthan the control group[(12.74±2.88)d,(44.73±7.12)d]afteRthe operation(P<0.05).3d~7d afteRoperation,VAS scores in the observation group were respectively(3.59±0.73)and(1.85±0.57),loweRthan those of the control group[(4.22±0.65),(3.12±0.61)](P<0.05).Three months afteRoperation,the observation group's serum OPN[(8.42±2.26)μg/L],CD44[(162.47±18.35)μg/L],BGP[(6.24±1.77)μg/L]and MMP-1[(5.25±1.36)μg/L]were loweRthan those of the control group[(13.36±2.37)μg/L,(216.54±20.33)μg/L,(7.59±1.74)μg/L,(6.52±1.47)μg/L](P<0.05);the observation group's Lysolm,KSS,IDKC scores were respectively[(87.92±6.74),(19.69±3.45),(89.95±7.36)],higheRthan those of the control group[(80.37±6.59),(15.73±2.84),(81.57±6.94)];the excellent rate of knee joint activity of the observation group(96.61%)was higheRthan that of the control group(86.44%)(P<0.05).Conclusion:Arthroscopic three tunnel reconstruction has a high curative effect on ACL injury of knee joint.It can shorten the rehabilitation process,advance the beginning of weight-bearing training,alleviate pain and promote knee joint function.