膝前交叉韧带断裂合并内侧副韧带Ⅲ度急性损伤一期联合修复重建的短期临床疗效研究

The Short-Term Clinical Efficacy of One-Stage Combined Repair and Reconstruction of Anterior Cruciate Ligament Rupture Combined with GradeⅢAcute Medial Collateral Ligament Injury

目的:探讨膝前交叉韧带(Anterior Cruciate Ligament,ACL)断裂合并内侧副韧带(Medial Collateral Ligament,MCL)Ⅲ度急性损伤一期联合修复重建的短期临床疗效。方法:回顾性分析2020年1月至2020年12月收治前交叉韧带断裂合并内侧副韧带Ⅲ度损伤34例患者的临床资料,手术距受伤时间为3~12 d,平均为7.2 d,均采用关节镜下一期前交叉韧带同种异体肌腱单骨道解剖重建合并内侧副韧带切开自体半腱肌转移重建术,通过记录术前及术后随访专科查体(Lachman试验、前抽屉试验、0°和30°外翻应力试验)、Lysholm评分、Tegner关节运动评分、国际膝关节评分委员会(IKDC)评分和膝关节活动度(ROM)来评估其临床疗效。结果:本组所有患者均获得随访,随访时间为12~24个月,平均为16.8个月,术口均Ⅰ期愈合,未发生感染、神经血管损伤及同种异体肌腱排异反应、关节僵硬等并发症。术后12个月Lachman试验、前抽屉试验、0°和30°外翻应力试验阳性率分别由术前88.2%,94.1%,85.3%和100%降低至8.8%,5.9%,2.9%和8.8%,差异有统计学意义(P<0.05);Lysholm评分、Tegner评分、IKDC评分和关节活动度分别由术前43.1±5.8,41.8±7.2,44.3±11.5和30.5°±10.5°提升至85.2±4.9,89.7±5.7,88.3±3.8和110.6°±14.4°,差异有统计学意义(P<0.05)。术后12个月均行患膝磁共振(MRI)复查,显示修复重建肌腱愈合良好。结论:膝前交叉韧带断裂合并内侧副韧带Ⅲ度急性损伤一期联合修复重建短期随访,可迅速恢复关节稳定性、关节功能及关节屈伸活动度,具有良好的临床疗效,值得进一步推广应用。

Objective:To investigate the short-term clinical efficacy of one-stage reconstruction of anterior cruciate ligament(ACL)rupture combined with gradeⅢacute medial collateral ligament(MCL)injury.Methods:The clinical data of 34 patients with ACL rupture combined with MCLⅢdegree injury admitted from January 2020 to December 2020 were retrospectively analyzed.The time from injury to operation was 3 to 12 d(mean,7.2 d).The clinical efficacy was evaluated by recording the preoperative and postoperative follow-up specialist physical examination(Lachman test,anterior drawer test,0°and 30°valgus stress test),Lysholm score,Tegner joint motion score,International Knee Documentation Committee(IKDC)score,and knee range of motion(ROM).Results:All patients were followed up for 12 to 24 months,with an average of 16.8 months.All surgical openings healed by first stage,and no complications such as infection,neurovascular injury,allograft tendon rejection and joint stiffness occurred.12 months after operation,the positive rate of special physical examination(Lachman test,anterior drawer test,0°and 30°valgus stress test)decreased from 88.2%,94.1%,85.3%and 100%before operation to 8.8%,5.9%,2.9%and 8.8%,respectively,and the difference was statistically significant(P<0.05).Lysholm score,Tegner score,IKDC score and ROM increased from 43.1±5.8,41.8±7.2,44.3±11.5,and 30.5°±10.5°to 85.2±4.9,89.7±5.7,88.3±3.8,and 110.6°±14.4°,respectively,and the difference was statistically significant(P<0.05).The magnetic resonance imaging(MRI)examination of the affected knee at 12 months after operation showed good healing of the repaired and reconstructed tendons.Conclusion:The short-term follow-up of one-stage combined repair and reconstruction of anterior cruciate ligament rupture combined with gradeⅢacute medial collateral ligament injury can quickly restore joint stability,joint function and joint flexion and extension range of motion,which has good clinical efficacy and is worthy of further application.