关节镜下前交叉韧带残端评估及保残重建的临床效果

Clinical outcome of arthroscopic anterior cruciate ligament reconstruction with remnant preservation after evaluation

目的探讨关节镜下前交叉韧带(ACL)残端评估及保残重建的临床效果。方法选取于我院行关节镜下人工韧带加强系统(LARS)移植重建ACL的患者111例,按照手术方式的不同分为Crain组(59例)及对照组(52例)。Crain组在改良Crain分型理论指导下保留残端并在鞘内重建ACL,对照组在ACL重建时清除残端。比较2组患者术前及术后24 h、72 h疼痛视觉模拟量表(VAS)评分。分别于术前及术后3个月、6个月、9个月和12个月采用Lysholm评分评估患者的膝关节功能。采用Lachman试验、轴移试验评估手术前后膝关节的稳定性。记录2组患者随访期间并发症发生情况。结果Crain组患者术后24 h、72 h VAS评分均低于对照组(P<0.05)。2组患者术前及术后9个月、12个月Lysholm评分比较差异无统计学意义(P>0.05),Crain组患者术后3个月、6个月Lysholm评分高于对照组(P<0.05)。2组患者手术前后Lachman试验及轴移试验阴性结果比较差异具有统计学意义(P<0.05),2组患者术后Lachman试验及轴移试验阴性结果比较差异无统计学意义(P>0.05)。对照组患者术后出现1例膝关节明显肿胀、疼痛,2组患者均未发生神经血管损伤及关节内感染等严重并发症。结论根据改良Crain分型理论进行关节镜下残端评估并保留残端的ACL重建可减轻膝关节疼痛,快速恢复膝关节功能和稳定性,严重并发症较少,临床效果满意。

Objective To investigate the clinical outcome of arthroscopic anterior cruciate ligament(ACL)reconstruction with remnant preservation after evaluation.Methods A total of 111 patients who underwent arthroscopic ligament advanced reinforcement system(LARS)transplantation to reconstruct ACL in our hospital were selected and divided into the Crain group(59 cases)and the control group(52 cases)according to different surgical methods.Patients in the Crain group preserved remnants and reconstructed ACL in the sheath under the guidance of modified Crain classification theory,and those in the control group cleared the remnants during ACL reconstruction.The pain visual analogue scale(VAS)scores before operation and 24 hours and 72 hours after operation were compared between the two groups.The Lysholm score was used to evaluate the function of knee joint before operation and 3 months,6 months,9 months and 12 months after operation.The Lachman test and the pivot shift test were used to evaluate the stability of knee joint before and after surgery.The compli‐cations of the patients in the two groups were recorded during the follow-up period.Results The VAS scores of patients 24 hours and 72 hours after operation in the Crain group were lower than those in the control group(P<0.05).There was no significant difference in the Lysholm scores before operation and 9 months and 12 months after operation between the two groups(P>0.05),and the Lysholm scores 3 months and 6 months after operation in the Crain group were higher than those in the control group(P<0.05).There were statistically significant differences in the negative results of the Lachman test and the pivot shift test before and after operation in the two groups(P<0.05),but no significant difference was found in negative results of the Lachman test or the pivot shift test after operation between the two groups(P>0.05).One patient in the control group had obvious swelling and pain in the knee joint after operation,and no serious complications such as neurovascular injury and intra-articular infection occurred in patients of the two groups.Conclusion Arthroscopic ACL reconstruction with remnant preservation evaluated by modified Crain classification theory can relieve the pain of knee joint and quickly restore the function and stability of knee joint,with fewer serious complications and satisfactory clinical results.