前外侧肌腱固定术在治疗合并高度轴移不稳定的前交叉韧带损伤患者中的应用

发布时间：2018-06-02 06:23

本文选题：前交叉韧带损伤 + 轴移试验　；参考：《中国运动医学杂志》2017年02期

【摘要】：目的:对合并高度轴移不稳定的前交叉韧带损伤患者,在前交叉韧带重建的手术过程中,施行前外侧肌腱固定,分析该方法对恢复膝关节稳定性的作用与临床效果。方法:2015年6月至2015年12月,共140例患者诊断为前交叉韧带损伤,于我科接受手术治疗。其中,18例患者在麻醉下检查轴移试验表现为2+至3+,入选本研究。在手术过程中,在重建前交叉韧带的基础上,取髂胫束后方纤维做前外侧肌腱固定。患者在术后即刻、6个月和12个月时接受临床随访,采用KT-1000检查膝关节前后向稳定性,采用轴移试验评估膝关节旋转稳定性。使用Lysholm主观功能评分评估膝关节功能。结果:18例患者平均获得12.7±2.4个月随访,男性14例,女性4例,平均年龄28.3±7.1岁。至最终随访时,全部患者无膝关节不稳定主诉。前后向稳定性KT-1000检查患侧-健侧差值平均为2.3±0.7 mm,与术前(9.2±2.6mm)相比有显著差异(P0.01)。术前麻醉下检查,13例患者轴移试验2+,5例患者3+。术后即刻检查轴移试验均为阴性。最终随访时,17例患者轴移试验阴性,1例患者1+,术后与术前相比有显著差异(P0.01)。患者Lysholm评分术前平均为67.7±5.9(55至78),术后为89.0±4.6(75至95),术后相比术前有显著改善(P0.001)。结论:对前交叉韧带损伤合并高度轴移试验阳性的患者,在重建前交叉韧带的同时,采用前外侧肌腱固定的方法,可有效改善轴移试验的结果,恢复关节稳定性,术后早期随访结果满意。
[Abstract]:Objective: to analyze the effect and clinical effect of anterior cruciate ligament (ACL) reconstruction with anterior cruciate ligament (ACL) reconstruction in patients with anterior cruciate ligament (ACL) injury. Methods: from June 2015 to December 2015, 140 patients were diagnosed with anterior cruciate ligament injury and operated in our department. The axial shift test was performed in 18 patients under anesthesia, and was included in this study. During the operation, the anterior cruciate ligament was reconstructed and the anterior lateral tendon was fixed with the posterior fiber of iliotibial tract. The patients were followed up immediately, 6 months and 12 months after operation. The anterior and posterior stability of knee joint was examined by KT-1000, and the rotation stability of knee joint was evaluated by axial shift test. Lysholm subjective function score was used to evaluate knee function. Results 18 patients were followed up for an average of 12.7 卤2.4 months, 14 males and 4 females, with an average age of 28.3 卤7.1 years. By the end of follow-up, all patients had no major complaints of knee instability. The average difference between the diseased side and the healthy side was 2.3 卤0.7 mm in anteroposterior stability KT-1000, which was significantly different from that before operation (9.2 卤2.6 mm). Preoperative anesthesia examination of 13 patients with axial shift test 2 and 5 patients with 3. The axial shift test was negative immediately after operation. At the end of follow-up, there were 17 cases with negative axial shift test (1 case) and 1 case with negative axial shift test (1 case). There was a significant difference between preoperative and postoperative patients (P 0.01). The average Lysholm score before operation was 67.7 卤5.9 to 78, and after operation was 89.0 卤4.675 to 95, which was significantly improved compared with that before operation (P 0.001). Conclusion: in the patients with anterior cruciate ligament injury and high axial shift test, anterior cruciate ligament reconstruction and anterior lateral tendon fixation can effectively improve the results of axial transfer test and restore joint stability. Early follow-up results were satisfactory.
【作者单位】：北京积水潭医院运动医学科;
【分类号】：R687.4

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