关节镜下腘绳肌腱贯穿股骨隧道联合重建前交叉韧带及前外侧韧带的疗效研究

Clinical effect of anterior cruciate ligament combined with anterolateral ligament reconstruction using the hamstring tendon penetrating the femoral tunnel

目的探讨关节镜下腘绳肌腱单束移植物贯穿股骨隧道联合重建前交叉韧带(ACL)及前外侧韧带(ALL)的手术技术,并比较术前、术后临床疗效。方法回顾性分析2020年10月—2022年7月河北医科大学附属秦皇岛市第一医院收治的20例ACL断裂合并ALL断裂患者的临床资料。所有患者均在关节镜下行贯穿股骨隧道的ACL联合ALL重建术。通过问卷调查的方式对患者术前及术后1年的膝关节功能进行Lysholm膝关节评分、国际膝关节文献委员会(IKDC)评分和Lachman试验分级评估,并应用膝关节活动测量仪和KT-2000测量仪对患者膝关节进行客观评估。比较患者手术前后Lysholm膝关节评分、IKDC评分、Lachman试验分级、膝关节屈伸活动度及胫骨前后向松弛度。计量资料以均数±标准差(±s)表示,手术前后比较采用t检验。配对等级资料手术前后比较采用Wilcoxon检验。结果20例患者手术均顺利完成,所有患者均获得随访,平均随访时间(12.2±1.4)个月,手术时间60~90 min。术后复查膝关节MRI,移植物固定良好,无膝关节僵硬、感染、深静脉血栓及神经血管损伤等常见并发症。20例患者末次随访时膝关节屈伸活动正常,其中2例患者Lachman试验I°弱阳性;Lysholm膝关节评分、IKDC评分分别由术前的(44.6±1.7)、(54.2±2.0)分提高到末次随访时的(87.5±1.3)、(89.6±1.0)分,膝关节屈伸活动度由术前的(35.0±1.5)°提高到末次随访的(134.2±2.5)°,膝关节稳定性及功能评分较术前明显改善,差异均具有统计学意义(P<0.05);屈膝90°KT-2000测量仪测量膝关节手术前后胫骨松弛度差异由术前的(11.9±1.0)mm降低到末次随访时的(1.9±0.3)mm,结果显示,膝关节稳定性较术前明显改善,手术前后比较差异具有统计学意义(P<0.05)。结论膝关节镜下腘绳肌腱单束移植物联合重建ACL及ALL的手术技术安全有效,可恢复患者膝关节旋转稳定性,术后中短期随访临床主客观功能评分指标满意。

Obiective To explore the surgical technique of arthroscopic reconstruction of the anterior cruciate ligament(ACL)combined with anterior lateral ligament(ALL)using the hamstring tendon graft through the femoral tunnel,and evaluate the clinical efficacy before and after surgery.Methods Retrospective analysis of clinical data of 20 patients with ACL combined with ALL rupture admitted to Qinhuangdao First Hospital of Hebei Medical University from October 2020 to July 2022.All patients received arthroscopic reconstruction of ACL combined with ALL using the hamstring tendon graft through the femoral tunnel.The Lysholm knee joint score,International Knee Documentation Committee(IKDC)score,and Lachman test were evaluated using a questionnaire survey,and objective evaluations were performed using a knee joint activity measurement instrument and a KT-2000 measurement instrument before and 1 year after surgery.Compare the Lysholm knee joint score,IKDC score,Lachman test grade,knee flexion and extension range of motion,and tibia anterior and posterior relaxation before and after surgery.The measurement data were represented by mean±standard deviation(±s),and t-test was used for comparison before and after surgery.The comparison of paired grade data before and after surgery was conducted using Wilcoxon test.Results All 20 patients underwent surgery successfully,and all patients were followed up for an average follow-up time of(12.2±1.4)months,with a surgical time of 60-90 minutes.Postoperative MRI examination of the knee joint showed good graft fixation and no common complications such as knee stiffness,infection,deep vein thrombosis,and neurovascular injury.At the last follow-up,the knee joint flexion and extension activities of 20 patients were normal,with 2 patients weakly positive for Lachman test I;the Lysholm knee joint score and IKDC score increased from preoperative(44.6±1.7)points and(54.2±2.0)points to final follow-up(87.5±1.3)points and(89.6±1.0)points,respectively.The knee joint flexion and extension range of motion increased from preoperative(35.0±1.5)°to final follow-up(134.2±2.5)°,and the knee joint stability and function score improved significantly compared to preoperative,and the difference was statistically significant(P<0.05);bend the knee 90°,KT-2000 measures the difference in tibial relaxation decreased from preoperative(11.9±1.0)mm to final follow-up(1.9±0.3)mm.The results showed that the stability of the knee joint was significantly improved compared to before surgery,and the difference before and after surgery was statistically significant(P<0.05).Conclusions The surgical technique of arthroscopic reconstruction of ACL and ALL using a single bundle of hamstring tendon graft under knee arthroscopy is safe and effective,and can restore the stability of knee joint rotation in patients.The clinical subjective and objective functional scoring indicators for short-term follow-up after surgery are satisfactory.