关节镜下不保留残端与保留残端前交叉韧带重建术的疗效对比

Comparison of Therapeutic Efficacy between Arthroscopic Anterior Cruciate Ligament Reconstruction without and with Residual Preservation

目的:对比观察关节镜下不保留韧带残端与保留韧带残端前交叉韧带重建术的临床疗效及生物力学指标。方法:选取2022年3月至2023年1月收治的膝关节前交叉韧带(ACL)损伤患者72例,将其分为对照组和观察组各36例。对照组按照常规操作彻底清理韧带残端,而观察组在保留韧带残端的前提下进行少量清理。两组均取自体同侧腘绳肌腱进行肌腱的编织和固定。观察两组术后6个月和12个月的关节功能(Lysholm评分及IKDC评分)、本体感觉(15°,45°,75°的被动关节活动度重现)、静态双足站立和动态行走的椭圆面积、步宽、步幅、双支撑相以及双腿垂直跳跃的髋关节屈曲、踝关节跖屈角度、膝关节伸展力矩、膝关节内旋力矩。结果:观察组术后6个月Lysholm评分高于对照组,差异有统计学意义(P<0.05),IKDC评分两组差异无统计学意义(P>0.05);观察组术后12个月Lysholm评分高于对照组,差异有统计学意义(P<0.05),IKDC评分两组差异无统计学意义(P>0.05)。3个角度(15°,45°,75°)的被动关节活动度重现,观察组均低于对照组,差异有统计学意义(P<0.05)。静态站立和行走多个参数中,观察组足底压力椭圆面积和双支撑相占比低于对照组,步幅高于对照组,差异有统计学意义(P<0.05),而步宽两组差异无统计学意义(P>0.05)。在双腿垂直跳跃的多个参数中,观察组髋关节屈曲低于对照组,膝关节伸展力矩大于对照组,差异有统计学意义(P<0.05),而踝关节跖屈和膝关节内旋力矩两组差异无统计学意义(P>0.05)。结论:关节镜下保留韧带残端与不保留韧带残端的前交叉韧带重建术相比,保留韧带残端更能够提高患者的关节功能评分和本体感觉能力,改善生物力学指标。

Objective:To compare the clinical efficacy and biomechanical indicators of arthroscopic anterior cruciate ligament(ACL)reconstruction without and with residual preservation.Methods:72patients with ACL injury from March 2022to January 2023were selected and divided into control group and observation group,with 36cases in each group.The control group thoroughly cleaned the residual ligaments according to routine procedures,while the observation group performed a small amount of cleaning while preserving the residual ligaments.Both groups received autologous ipsilateral hamstring tendons for tendon weaving and fixation.Observe the joint function(Lysholm score,IKDC score),proprioception(reproduction of passive joint range of motion at 15°,45°,and 75°),elliptical area,stride width,stride length,biphasic support,hip flexion,ankle plantar flexion angle,knee extension torque,and knee internal rotation torque of two groups of patients at 6and 12months post surgery.Results:The Lysholm score of the observation group was higher than that of the control group at 6months of surgery(P<0.05),and there was no difference in the IKDC score between the two groups(P>0.05).The Lysholm score of the observation group was higher than that of the control group at 12months(P<0.05),and there was no difference in the IKDC score between the two groups(P>0.05).The passive joint range of motion was reproduced at three angles(15°,45°,75°),and the observation group was lower than the control group(P<0.05).Among the multiple parameters of static standing and walking,the observation group had a lower proportion of plantar pressure ellipse area and double support compared to the control group,and a higher stride than the control group(P<0.05);There was no significant difference in step width between the two groups(P>0.05).Among the multiple parameters of leg vertical jumping,the observation group had lower hip flexion than the control group,and greater knee extension torque than the control group(P<0.05);However,there was no significant difference(P>0.05)in the ankle plantar flexion and knee internal rotation torque between the two groups.Conclusion:Arthroscopic anterior cruciate ligament reconstruction surgery with and without residual ligament preservation can better improve joint function scores and proprioceptive ability,as well as improve biomechanical indicators in patients.