关节镜下保留残端与非保留残端重建前交叉韧带的临床疗效分析

摘要

目的 探讨关节镜下保留残端与非保留残端重建前交叉韧带的方法与疗效.方法 2012年6月～2015年12月收治前交叉韧带断裂患者48例,采用自体腘绳肌肌腱重建,可吸收挤压螺钉固定重建肌腱.保残前交叉韧带重建20例,保留断裂的前交叉韧带残端;非保残前交叉韧带重建28例,断裂的前交叉韧带完全清理.两组均术后随访24个月,采用KT-2000胫骨前移距离、Lysholm膝关节评分、被动活动察觉阈值进行疗效评估.结果 在术后24个月的随访中,术后3、6个月KT-2000胫骨前移距离同期保残组显著高于非保残组(T=5.290,P=0.000;T=3.754,P=0.000),术后12、24个月Lysholm膝关节评分同期保残组显著高于非保残组(T=3.187,P=0.003;T=3.781,P=0.000),术后12、24个月被动活动察觉阈值同期保残组显著高于非保残组(T=4.229,P=0.000;T=3.105,P=0.003).结论 纤维关节镜下保留残端前交叉韧带重建比不保残重建在恢复膝关节运动功能方面具有更好的优势.%Objective To evaluate the methods and therapeutic effects of the anterior cruciate ligament(ACL)reconstruction with remnant preservation and no preservation under arthroscopy.Methods A total of 48 patients with ACL injury in the Wuhan General Hospital of the Chinese People's Liberation Army Command from Jun.2012 to Dec.2015 were enrolled in this study.They received the ACL reconstruction by using hamstring tendon autograft fixed with bioabsorbable interference screw.20 patients were treated with ACL reconstruction with remnant preservation,while 28 patients were treated with ACL reconstruction without remnant preservation.All the patients were followed up with a mean period of 24 months.Each patient was evaluated using the following variables:forward distance measured by KT-2000,Lysholm knee score,the threshold index of perception under passive movement.Results During the follow-up of 24 months,the forward distance by KT-2000 3,6 months after operation in the remnant preservation group was significantly better than that of the non preservation group at the same time(T=5.290,P=0.000;T=3.754,P=0.000).The Lysholm score was apparently higher in the remnant preservation group than in the non preservation group 12,24 months after surgery(T=3.187,P=0.003;T=3.781,P=0.000).The threshold index of perception under passive movement in the remnant preservation group was significantly better than that of the non preservation group 12,24 months after operation(T=4.229,P=0.000;T=3.105,P=0.003).Conclusion Remnant preservation under arthroscopy in ACL reconstruction can provide better recovery of the knee joint movement function after the surgery than non preservation.