股骨端悬吊固定双束前交叉韧带重建前瞻性研究

摘要

目的 评估股骨端悬吊固定双束重建前交叉韧带(Anterior Cruciate Ligament,ACL)的临床疗效.方法 采用前瞻性对比研究方法.纳入标准:单纯ACL陈旧性损伤,无膝关节其他韧带损伤,受伤与手术至少间隔2个月.自2005年5月-2008年6月,符合纳入标准的患者62例,根据入院先后顺序随机分成Ⅰ组和Ⅱ组,每组31例,两组患者相关影响因素无统计学差异.Ⅰ组:股骨端依靠两个骨道悬吊固定.Ⅱ组:股骨端采用两枚可吸收挤压钉固定;两组胫骨端均采用双骨道,应用可吸收挤压钉与缝线悬吊复合固定.所有手术由同一手术组完成.每位患者术前及术后2年进行Lysholm评分,Cincinnati膝关节评分(the Cincinnati knee rating system),IKDC评分(the International Knee Documentation Committee score),KT2000检查及膝关节活动度检查.结果 Lysholm评分Ⅰ组(91±7)分、Ⅱ组(89±9)分(P=0.088);Cincinnati膝关节评分Ⅰ组(93±6)分,Ⅱ组(90±8)分,(P=0.189);客观IKDC评分Ⅰ组正常71％、基本正常26％,Ⅱ组正常58％、基本正常35％(P=0.221);在134N下KT-2000胫骨前移两侧对比测试Ⅰ组(1.3±1.2)mm、Ⅱ组(1.4±1.3)mm(P=0.196);膝关节活动度Ⅰ组(136±10)度、Ⅱ组(130±15)度(P=0.029).结论 股骨端悬吊固定与股骨端挤压钉固定双束ACL重建方法比较,膝关节功能评分及前后稳定性测试无统计学差异,但膝关节活动度悬吊固定组优于挤压钉固定组.%Objective To assess the therapeutic effect of sling femoral fixation technique on reconstruction of double-bundle anterior cruciate ligament(ACL). Methods A prospective study was involved in this study. The inclusion criteria were a simple chronic ACL rupture without injury of other knee ligaments, and the time between injury and operation being at least 2 months. The study was carried out from May 2005 to June 2008. Sixty-two patients included in this study were randomly divided into 2 groups, 31 in each group, with no statistical difference in related influencing factors between the 2 groups. Patients in group I were treated with sling femoral fixation was carried out. Patients in group II were treated with interference screw fixation of the femoral end. Patients in both groups were treated with biodegradable interference screw fixation of the tibia. All operations were performed by the same surgeon group. Each patient was scored using the Lysholm scoring system, Cincinnati knee rating system. International Knee Documentation Committee(IKDC) rating system, The anterior tibia displacement length measured with KT-2000 at 134N, and the knee motion was examined, respectively, before and 2 years after operation. Results The Lysholm score was (91 ± 7) and (89 ± 9) for groups 1 and 11. Respectively(P=0.088). The Cincinnati knee score was (93 ± 6) and (90 ±8) for groups 1 and II, respectively(P=0.189). The objective 1KDC rate was 71% and 26% for group I. And 58% and 35% for group II, respective!y(P=0.221). The average anterior tibia displacement length was (1.3 ± 1.2)mm for group I. And (1.4 ± 1.3)mm for group II(P=O.I96). The knee motion was (136 ± 10) degree for group I and (130 ± 15) degree for group II (P=0.029). Conclusion The function score and stability test for the knee joint are not significantly different after reconstruction of double-bundle ACL with sling femoral fixation and screw fixation. The knee motion is better after sling femoral fixation than after screw fixation.