关节镜下改良双束修复前交叉韧带Sherman Ⅰ型损伤

Modified double-bundle arthroscopic repair of the anterior cruciate ligament after Sherman type Ⅰ injury

背景:前交叉韧带重建术后产生的腘绳肌肌力减弱、髌前区疼痛、重建后较高的骨关节炎发生率及本体感觉丧失等问题导致术后功能恢复不佳;前交叉韧带关节镜下修补结合动态或静态增强修补,保留了原有韧带结构,并取得了良好的近期疗效。目的:观察关节镜下改良双束修复前交叉韧带Sherman Ⅰ型损伤的功能疗效及影像学表现。方法:选择2020年1月至2022年9月在佛山市中医院运动医学科就诊的前交叉韧带损伤患者60例,根据治疗方案分为2组,每组30例,修复组采用双束修补结合内支架固定,重建组采用自体腘绳肌单束解剖重建。术后所有病例随访12个月,分别于术后3,6,12个月评估两组患者国际膝关节评分委员会评分、Lysholm评分及KT-1000患侧-健侧差值。结果与结论:①术后3个月,两组患者的国际膝关节评分委员会评分、Lysholm评分及KT-1000患侧-健侧差值比较差异均有显著性意义(P<0.05),术后功能修复组优于重建组;②术后6,12个月,两组患者的国际膝关节评分委员会评分、Lysholm评分及KT-1000患侧-健侧差值比较差异无显著性意义(P>0.05);③结果表明,前交叉韧带修复保留了原有韧带结构,避免了因重建钻取较大的骨髓道及自体肌腱取出,可减少对原有正常结构的损伤,并发症少,术后早期疗效优于前交叉韧带保残重建,但术后6个月之后两组疗效无明显差异。

BACKGROUND:Impaired hamstring muscle strength,anterior patellar pain,high incidence of osteoarthritis,and loss of proprioception after anterior cruciate ligament reconstruction lead to poor functional recovery due to a higher incidence of osteoarthritis and loss of proprioception.Arthroscopic repair of the anterior cruciate ligament combined with dynamic or static internal brace repair preserves the original ligament structure and results in favorable short-term outcomes.OBJECTIVE:To prospectively observe the efficacy and imaging findings of modified double-bundle arthroscopic repair of the anterior cruciate ligament after Sherman type I injury.METHODS:From January 2020 to September 2022,a total of 60 patients with anterior cruciate ligament injury admitted at the Department of Sports Medicine,Foshan Hospital of Traditional Chinese Medicine were included and divided into two groups(n=30 per group)according to the treatment protocols.The functional repair group was treated with double bundle repair combined with internal brace fixation,and the reconstruction group was treated with single bundle anatomical reconstruction of autologous hamstring muscle.All cases were followed up for 12 months after surgery,and International Knee Documentation Committee score,Lysholm score and KT-1000 difference between the affected and healthy sides of the two groups were evaluated at 3,6 and 12 months after surgery.RESULTS AND CONCLUSION:Three months after surgery,International Knee Documentation Committee scores,Lysholm scores and KT-1000 difference between the affected and healthy sides were significantly different between the two groups(P<0.05),and the functional repair group was better than the reconstruction group.At 6 and 12 months after surgery,there was no significant difference in International Knee Documentation Committee score,Lysholm score and KT-1000 difference between the two groups(P>0.05).To conclude,anterior cruciate ligament repair preserves the original ligament structure,avoids drilling larger marrow tracts and removing autologous tendons for reconstruction,reduces the damage to the original normal structure,and has fewer complications.Early postoperative efficacy is better than that of anterior cruciate ligament reconstruction with stumps,but there is no significant difference in the efficacy of the two groups 6 months after surgery.