股骨侧I.D.E.A.L定位在单束前交叉韧带重建术中的应用研究

Application of femoral I.D.E.A.L localization in anterior cruciate ligament reconstruction with single bundle anterior cruciate ligament

目的:评估股骨侧I.D.E.A.L定位在单束前交叉韧带重建术(anterior cruciate ligament reconstruction,ACLR)中的应用效果。方法:回顾性分析2019年1月至2022年10月,采用ACLR治疗的122例前交叉韧带损伤患者,其中男83例,女39例;年龄23~43(32.19±8.55)岁;病程1周~6个月。根据手术方案不同分为传统组和I.D.E.A.L组。传统组64例,男43例,女21例;年龄24~41(31.22±9.46)岁;采用over-the-top股骨侧定位方案;I.D.E.A.L组58例,男40例,女18例;年龄23~43(32.09±9.14)岁;采用I.D.E.A.L股骨侧定位方案。术前患者存在膝关节的疼痛伴功能障碍,膝关节MRI提示前交叉韧带损伤。视觉模拟评分(visual analogue scale,VAS)系统评价疼痛缓解程度,国际膝关节文献委员会(International Knee Documentation Committee,IKDC)评分系统和Lysholm评分系统评估患者的膝关节功能,利用KT-2000检测膝关节术后的恢复情况,并观察其术后并发症。结果:术后患者伤口愈合良好,122例获随访,时间15~46(25.45±9.22)个月。I.D.E.A.L组患者术后1 d、1周的VAS低于传统组(P<0.05),I.D.E.A.L组患者术后1 d和1周的IKDC评分和Lysholm评分高于传统组(P<0.05)。传统组术后近期(<1个月)并发症6例,术后远期(≥1个月)并发症19例;I.D.E.A.L组术后近期并发症3例,术后远期并发症7例;I.D.E.A.L组患者并发症均少于传统组(P<0.05)。结论:单束前交叉韧带重建术股骨侧I.D.E.A.L定位可以取得更佳的术后早期效果,降低术后早期疼痛。

Objective To evaluate the effect of femoral I.D.E.A.L localization in single bundle anterior cruciate ligament reconstruction(ACLR).Methods From January 2019 to October 2022,122 patients with anterior cruciate ligament injury were treated with ACLR,including 83 males and 39 females.The age ranged from 23 to 43 years old,with an average of(32.19±8.55)years old.The course of disease ranged from 1 week to 6 months.According to the different surgical schemes,the patients were divided into two groups,namely the traditional group,which adopted the over-the-top femoral lateral positioning scheme,including 64 patients.The I.D.E.A.L group adopted the I.D.E.A.L femoral lateral positioning scheme,including 58 patients.The patient has pain and dysfunction of knee joint before operation.MRI of knee joint indicates anterior cruciate ligament injury.The visual analogue scale(VAS),International Knee Documentation Committee(IKDC)scoring system and Lysholm scoring system were used to evaluate the knee joint function of the patient.KT-2000 was used to detect the recovery of knee joint after operation and to count the postoperative complications.Results The wounds healed well after operation.One hundred and twenty-tow patients were followed up for 15 to 46 months,with an average of(25.45±9.22)months.The knee joint stability of patients after operation was significantly increased.The VAS at 1 day and 1 week after operation of patients in the I.D.E.A.L group was significantly lower than that in the traditional group(P<0.05).The IKDC score and Lysholm score of patients in the I.D.E.A.L group were significantly higher than those in the traditional group(P<0.05).In the traditional group,there were 6 cases of short-term(<1 month)complications and 19 cases of long-term(≥1 month)complicatios.In the I.D.E.A.L group,there were 3 cases of short-term complications and 7cases of long-term complications(P<0.05).Conclusion The single bundle anterior cruciate ligament reconstruction and femoral I.D.E.A.L positioning can achieve better early postoperative effect and reduce early postoperative pain.