膝关节镜下应用不同自体材料重建前交叉韧带的效果观察

Application effects of different autologous tissues in anterior cruciate ligament reconstruction under knee arthroscopy

目的探究膝关节镜下应用不同自体材料重建前交叉韧带的效果。方法选取2019年12月至2021年12月铜川市人民医院收治的交叉韧带断裂者90例,按随机数表法分为观察组和对照组各45例。观察组采取1/3髌韧带自体材料,对照组使用双股半腱肌腱自体材料,分别比较两组患者术前和术后1个月、3个月、6个月的Lysholm膝关节评分、Tegner膝关节评分、视觉模拟疼痛(VAS)评分、疼痛程度数字评分(NRS),同时比较两组患者术前和术后3 d、5 d、7 d的超敏C反应蛋白(hs-CRP)水平和红细胞沉降率(ESR)。结果观察组患者术后1个月、3个月、6个月的Lysholm得分分别为(61.23±8.12)分、(79.87±7.22)分、(88.87±9.12)分,明显高于对照组的(58.88±9.13)分、(69.72±7.41)分、(79.97±8.68)分,差异均有统计学意义(P<0.05);观察组患者术后1个月、3个月、6个月的Tegner评分分别为(4.17±1.01)分、(5.39±1.24)分、(7.64±1.12)分,明显高于对照组的(3.32±0.87)分、(4.44±1.07)分、(6.17±1.31)分,差异均有统计学意义(P<0.05);观察组患者术后1、3、6个月的VAS评分分别为(5.17±1.11)分、(4.03±1.13)分、(3.11±0.87)分,明显低于对照组的(6.24±1.54)分、(5.29±1.01)分、(4.17±0.99)分,差异均有统计学意义(P<0.05);观察组患者术后1个月、3个月、6个月的NRS评分分别为(5.58±0.96)分、(4.13±1.09)分、(3.06±0.82)分,明显低于对照组的(6.11±1.02)分、(5.17±1.36)分、(4.03±0.94)分,差异均有统计学意义;观察组患者术后3 d、5 d、7 d的hs-CRP分别为(21.22±5.41)mg/L、(32.88±8.17)mg/L、(44.12±10.11)mg/L,明显低于对照组的(34.11±5.64)mg/L、(46.78±8.24)mg/L、(68.12±10.24)mg/L,ESR分别为(28.92±5.17)mm/h、(37.11±6.09)mm/h、(43.86±7.26)mm/h,明显低于对照组的(32.67±5.83)mm/h、(41.28±7.13)mm/h、(50.16±8.25)mm/h,差异均有统计学意义(P<0.05)。结论1/3髌韧带自体材料重建前交叉韧带的效果更佳,能够更加有效改善膝关节功能,缓解疼痛,减少炎性反应。

Objective To explore the application effects of different autologous tissues in anterior cruciate ligament reconstruction under knee arthroscopy.Methods A total of 90 patients with cruciate ligament rupture who were admitted to Tongchuan People's Hospital from December 2019 to December 2021 were selected and divided into an observation group and a control group by random number table method,with 45 cases in each group.1/3 patellar ligament autograft was used in the observation group,and double strand semitendinosus tendon autograft was used in the control group.The Lysholm scores,Tegner scores,Visual Analogue Scale(VAS)scores,and Numerical Rating Scale(NRS)scores of the two groups before operation and at 1 month,3 months,and 6 months after operation were comparatively analyzed.High-sensitivity C-reactive protein(hs-CRP)level and erythrocyte sedimentation rate(ESR)before operation and on day 3,day 5 and day 7 after operation were compared between the two groups.Results At 1 month,3 months and 6 months after operation,Lysholm scores of the observation group were(61.23±8.12)points,(79.87±7.22)points,and(88.87±9.12)points,significantly higher than(58.88±9.13)points,(69.72±7.41)points,and(79.97±8.68)points of the control group(P<0.05).At 1 month,3 months and 6 months after operation,Tegner scores of the observation group were(4.17±1.01)points,(5.39±1.24)points,and(7.64±1.12)points,significantly higher than(3.32±0.87)points,(4.44±1.07)points and(6.17±1.31)points of the control group(P<0.05).At 1 month,3 months and 6 months after operation,the VAS scores of the observation group were(5.17±1.11)points,(4.03±1.13)points,and(3.11±0.87)points,significantly lower than(6.24±1.54)points,(5.29±1.01)points,and(4.17±0.99)points of the control group(P<0.05).At 1 month,3 months,and 6 months after operation,the NRS scores of the observation group were(5.58±0.96)points,(4.13±1.09)points,and(3.06±0.82)points,significantly lower than(6.11±1.02)points,(5.17±1.36)points,and(4.03±0.94)points of the control group(P<0.05).The levels of hs-CRP in the observation group on day 3,day 5 and day 7 after operation were(21.22±5.41)mg/L,(32.88±8.17)mg/L,and(44.12±10.11)mg/L,significantly lower than(34.11±5.64)mg/L,(46.78±8.24)mg/L,and(68.12±10.24)mg/L in the control group(P<0.05).ESR in the observation group on day 3,day 5 and day 7 after operation were(28.92±5.17)mm/h,(37.11±6.09)mm/h,and(43.86±7.26)mm/h,significantly lower than(32.67±5.83)mm/h,(41.28±7.13)mm/h,and(50.16±8.25)mm/h in the control group(P<0.05).Conclusion 1/3 patellar ligament can achieve better effect inanterior cruciate ligament reconstruction,which can improve knee function,relieve pain,and reduce inflammatory response more effectively.