镜下全内技术后交叉韧带重建与常规技术比较

Comparison of posterior cruciate ligament reconstruction by allinside and conventional arthroscopic techniques

[目的]比较镜下全内技术与常规技术重建后交叉韧带(posterior cruciate ligament, PCL)的临床结果。[方法]回顾性分析2016年7月—2021年7月镜下重建PCL 74例患者的临床资料。依据医患沟通结果,31例采用自体半腱肌肌腱为移植物,以全内技术PCL重建(全内组),另外43例采用异体肌腱为移植物,常规镜下PCL重建(常规组)。比较两组围手术期、随访及影像资料。[结果]全内组在切口总长度[(7.1±1.3) cm vs (10.3±2.4) cm, P<0.001]、下地行走时间[(3.4±2.1) d vs (5.6±3.2) d,P<0.001]、早期并发症发生率(3.2%vs 9.3%, P=0.043)、住院时间[(7.4±1.8) d vs (10.3±3.6) d, P<0.001]均显著优于常规组。全内组恢复完全负重活动时间显著早于常规组[(93.6±11.7) d vs (128.4±12.4) d, P<0.001]。术后两组VAS评分、Lysholm评分、IKDC评级、膝伸屈ROM、后抽屉试验和后向Lachman试验均显著改善(P<0.05),术后3个月和末次随访时,全内组的膝伸屈活动度[(124.4±3.6)°vs (116.5±3.2)°, P<0.001;(138.7±3.6)°vs (132.6±5.8)°, P<0.001]、Lysholm评分[(124.4±3.6) vs (116.5±3.2), P<0.001;(138.7±3.6) vs (132.6±5.8), P<0.001]和IKDC评级均显著优于常规组。影像方面,术后3个月,全内组股骨隧道内口缩小[例,缩小/无变化/扩大,(23/8/0) vs (13/27/3), P<0.001]占比显著优于常规组(P<0.05)。[结论]应用镜下全内技术PCL重建膝PCL的临床结果优于常规镜下PCL重建。

[Objective]To compare the clinical outcomes of posterior cruciate ligament(PCL)reconstruction by all-inside and conven-tional arthroscopic techniques.[Methods]A retrospective study was performed on 74 patients who underwent arthroscopic PCL reconstruc-tion from July 2016 to July 2021.According to doctor-patient discussion,31 patients received all-inside PCL reconstruction with autoge-nous semitendinosus tendon graft(the all-inside group),while the other 43 patients underwent conventional arthroscopic PCL reconstruc-tion with allogeneic tendon graft(the routine group).The perioperative,follow-up and imaging data of the two groups were compared.[Results]The all-inside group proved significantly superior to the routine group in terms of total incision length[(7.1±1.3)cm vs(10.3±2.4)cm,P<0.001],the walking time[(3.4±2.1)days vs(5.6±3.2)days,P<0.001],early complication rate(3.2%vs 9.3%,P=0.043)and hospitalstay[(7.4±1.8)days vs(10.3±3.6)days,P<0.001].In addition,the all-inside group resumed full weight-bearing activities significantly earli-er than the routine group[(93.6±11.7)days vs(128.4±12.4)days,P<0.001].The VAS score,Lysholm score,IKDC grade,knee flexion-ex-tension ROM,posterior drawer test and backward Lachman test significantly improved in both groups over time(P<0.05).The all-insidegroup was significantly better than the routine group in terms of knees ROM[(124.4±3.6)°vs(116.5±3.2)°,P<0.001;(138.7±3.6)°vs(132.6±5.8)°,P<0.001],Lysholm score[(124.4±3.6)vs(116.5±3.2),P<0.001;(138.7±3.6)vs(132.6±5.8),P<0.001]and IKDC grades 3months postoperatively and at the latest follow-up.Regarding imaging,the all-inside group was also significantly better than the routinegroup in femoral tunnel variation[case,reduced/no change/enlargement,(23/8/0)vs(13/27/3),P<0.001].[Conclusion]The all-inside ar-throscopic PCL reconstruction is superior in term of clinical consequence to the conventional arthroscopic PCL reconstruction for this liga-ment rupture.