前交叉韧带包膜内急性断裂非手术治疗的临床研究

摘要

目的:针对性选择前交叉韧带(anterior cruciate ligament,ACL)包膜内急性断裂的非专业运动员患者,研究非手术治疗达到愈合的效果及可行性.方法:2014年5月至2016年7月,门诊诊断ACL包膜内急性断裂患者28例纳入研究.所有患者均戴支具限制胫骨前移6周,然后进行膝关节活动度练习并继续用支具保护.诊后3月MRI显示连续性完全恢复,胫骨前向松弛度差值小于5 mm的患者在诊后6月及12月继续随访稳定性并进行MRI评估,最终进行临床功能评分.结果:4例患者在诊后3月未达到要求退出治疗,其中3例接受手术重建,1例接受肌力训练等保守治疗.1例在诊后5月再伤,接受手术重建.23例患者达到临床愈合.诊后12月,胫骨前向松弛差值平均为2.1 mm(0～4 mm).MRI评估1级8例,2级15例,优良率85.2％.主观IKDC评分平均为92.71(89.7～98.9).Lysholm膝关节评分平均为91.6(86～95).改良Larson膝关节韧带损伤评分平均为96.4(92～99).结论:ACL急性包膜内断裂经过系统的非手术治疗,影像学显示愈合优良率较高,膝关节的稳定性可满足一般运动需要.%Objective To evaluate the effectiveness of non-operative treatment for the acute intra-synovial sheath anterior cruciate ligament (ACL) rupture.Methods Twenty-eight patients diagnosed as the acute intra-synovial sheath ACL rupture at outpatient clinic between May 2014 and July 2016 were included.All patients were immobilized with knee braces for 6 weeks,followed by range of motion (ROM) training and partial to full weight-bearing of knees.All patients returned 3 months later for MRI scanning and those with the side-to-side difference of the anterior-posterior laxity less than 5 mm continued with non-operative treatment,followed up for MRI examination and clinical assessments 6 and 12 months later.Results Four patients dropped out because they didn't meet the stability criteria at 3 months after the treatment,3 of whom received surgical reconstruction and 1 with muscle strengthening training.Another patient received surgical reconstruction at 5 months due to re-injury.The remaining 23 patients achieved satisfactory results at 12 months after the treatment,with the average side-to-side difference of the anterior-posterior laxity of 2.1mm (0-4 mm),MRI good-to-excellent rate of 85.2％ (8 of Grade 1 and 15 of Grade 2),subjective IKDC (International Knee Documentation Committee) score of 92.71 (89.7-98.9),Lysholm score of 91.6 (86-95),and modified Larson score 96.4 (92-99).Conclusions Patients with the acute intra-synovial sheath anterior cruciate ligament (ACL) rupture showed satisfactory functional scores and objective stability and healing on MRI after the non-operative treatment.