前交叉韧带断裂不同中医证型患者前外侧旋转失稳情况的差异性研究

Correlation between anterior cruciate ligament rupture and anterolateral rotational instability with different traditional Chinese medicine(TCM)syndrome

目的探究前交叉韧带(ACL)断裂不同中医证型患者前外侧旋转失稳情况的差异性,为ACL断裂的中医病因病机深化及扩充提供可靠的临床依据。方法选取2020年1月至2020年6月于四川省骨科医院膝关节运动损伤科因ACL断裂行ACL重建术治疗的住院患者,并对患者进行中医辨证分为气滞血瘀证组、筋脉失养证组及湿阻筋络证组,收集所有患者的一般资料,包括年龄、性别、体质量指数(BMI)、Beighton评分、外侧胫骨平台后倾角,统计患者的受伤次数及平均病程,并在全麻下进行轴移试验评估患者前外侧旋转失稳情况,分析不同证型组间的差异性。结果共收集到病例154例,进一步进行中医辨证分型分组,其中气滞血瘀证组91例,筋脉失养证组33例,湿阻筋络证组30例,3组一般资料比较差异均无统计学意义(P>0.05),具有可比性。3组受伤次数组间比较差异有统计学意义(P<0.001,F=117.107),其中湿阻筋络证组患者受伤次数最多,其次是筋脉失养证组,气滞血瘀证组最少。3组平均病程组间比较差异有统计学意义(P<0.001,F=381.288),其中湿阻筋络证组患者病程最长,其次是筋脉失养证组,气滞血瘀证组最短。3组轴移试验结果组间比较差异有统计学意义(P<0.001,χ^(2)=33.110),其中湿阻筋络证组高度轴移率最高,其次是筋脉失养证组,气滞血瘀证组最低。结论ACL断裂湿阻筋络证患者前外侧旋转失稳情况最明显,其病程最长,受伤次数最多,高度轴移的发生率最高,其次是筋脉失养证、气滞血瘀证。

Objective Explore the correlation between anterior cruciate ligament(ACL)rupture and the degree of anterolateral rotation instability of different TCM syndromes.Provide a reliable clinical basis for the deepening and expansion of the TCM etiology and pathogenesis of the anterior cruciate ligament rupture.Methods A total of 154 patients who underwent ACL reconstruction due to rupture in Sichuan Orthopedic Hospital from January 2020 to June 2020 were enrolled.The patients were assigned into qi blood stasis(QBS)group,musculoskeletal dystrophy(MD)group,and dampness musculoskeletal(DM)group according to TCM syndrome differentiation.The general data of all patients were collected,including age,sex,body mass index(BMI),Beighton score,and posterior slope of lateral tibial plateau.The injuries number and the mean duration were counted.Under general anesthesia,the pivot-shift test was performed to evaluate the anterolateral rotation instability of patients,and the differences among three groups were analyzed.Results A total of 154 cases were collected,including 91 cases in QBS group,33 cases in MD group,and 30 cases in DM group.The general data were comparable among groups(P>0.05).There were statistically significant differences in the injuries number of among groups(P<0.001,F=117.107),which in the DM group were more than MD group and the QBS group.The mean duration was a significant difference among groups(P<0.001,F=381.288),DM group had the most prevalent,and the QBS group was the shortest.The results of the pivot-shift test were significantly different(P<0.001,χ^(2)=33.11).DM group had the highest axial shift rate,followed by the MD group and the QBS group.Conclusion ACL rupture patients with DM have a longer course of disease,more preoperative injuries,a higher incidence of high-grade pivot-shift,and more prone to severe anterolateral rotation instability than those with MD and QBS.