异体肌腱重建前交叉韧带术后临床效果及关节镜下再探查分析

发布时间：2018-02-17 02:44

本文关键词： 前交叉韧带异体肌腱疗效关节镜再探查　出处：《中国矫形外科杂志》2017年08期 　论文类型：期刊论文

【摘要】：[目的]探讨采用异体肌腱重建膝关节前交叉韧带(anterior cruciate ligament,ACL)术后移植物的转归,为术后康复提供指导依据。[方法]2012年1月~2015年12月对行ACL重建术后1年以上的患者58例(58膝)进行随访,同时进行患膝关节镜下再探查(second-look);ACL重建手术时患者年龄18~52岁,平均(30.7±9.9)岁,均采用深冻异体肌腱作为重建移植物。比较手术前后膝关节功能恢复情况(Lysholm评分及International Knee Documentation Committee,IKDC评分)及膝关节前向稳定性(前抽屉试验、Lachman试验变化以及KT-1000侧侧差值);行二次关节镜检查,观察移植物连续性、移植物滑膜覆盖情况以及关节内是否有异生结构等。[结果]所有患者未发生感染、严重排异反应及其他严重并发症。ACL重建术后至末次随访时间为12~33个月,所有患者均行关节镜下再探查。末次随访时除1例患者出现约10°伸直受限,其余患者膝关节活动度基本正常。Lysholm评分由术前的(55.64±9.43)分提高至末次随访时的(86.40±4.78)分,IKDC评分由术前的(55.73±9.97)分提高至末次随访时的(85.75±4.97)分,差异有统计学意义(P0.05);KT-1000侧侧差值由术前的(6.62±1.28)分提高至末次随访时的(1.57±0.98)分,差异有统计学意义(P0.05)。关节镜下再探查结果:3例出现移植物完全吸收,连续性不佳;3例出现ACL移植物磨损;2例患者关节腔内可见Cyclops样结节。滑膜覆盖评价:移植物滑膜覆盖优22例,良24例,差12例;滑膜覆盖优良率为79.3%。滑膜覆盖优组和良组其Lysholm评分、IKDC评分、KT-1000侧-侧差值均优于滑膜覆盖差组,差异有统计学意义(P0.05)。[结论]采用异体肌腱ACL重建术后移植物血管化、滑膜化进程慢,康复计划应相对缓慢;关节镜下再探查所见能够作为术后康复的良好依据。
[Abstract]:[objective] to investigate the outcome of anterior cruciate ligament (ACL) graft reconstruction with allogeneic tendon after anterior cruciate ligament (ACL) reconstruction. [methods] from January 2012 to December 2015, 58 patients (58 knees) who underwent ACL reconstruction were followed up. Deep frozen allogeneic tendons were used to reconstruct the grafts. The functional recovery of knee joint before and after operation was compared with that of International Knee Documentation Committee IKDC and the forward stability of knee joint (Lachman test in anterior drawer test and the difference between KT-1000 side and side) were compared. Second arthroscopy, The graft continuity, synovial coverage and allogenic structure were observed. [results] No infection was found in all the patients, and the follow-up time from severe rejection and other serious complications to the last follow-up period was 12 ~ 33 months. All patients underwent arthroscopic reexploration, except for one patient with limited extension of about 10 掳at the last follow-up. The knee motion of other patients was normal. Lysholm score increased from 55.64 卤9.43 before operation to 86.40 卤4.78 at the last follow-up. The IKDC score increased from 55.73 卤9.97 to 85.75 卤4.97 at the last follow-up. The difference was significantly increased from 6.62 卤1.28 to 1.57 卤0.98 at the last follow-up, and the difference was statistically significant (P 0.05). The results of arthroscopic reexamination showed that the graft was completely absorbed in 3 cases. Cyclops like nodules could be seen in articular lumen of 2 patients with ACL graft wear in 3 cases with poor continuity. Synovial coverage was excellent in 22 cases, good in 24 cases and poor in 12 cases. The excellent and good rate of synovial covering was 79.3%. The Lysholm score and KT-1000 side-side difference of the excellent and good synovial covering group were better than that of the poor synovial covering group (P 0.05). [conclusion] the graft vascularization was reconstructed by allogeneic tendon ACL. The synovialization process is slow and the rehabilitation plan should be relatively slow, and the re-exploration under arthroscopy can be used as a good basis for postoperative rehabilitation.
【作者单位】：河北医科大学第三医院关节科;河北医科大学河北省骨科生物力学重点实验室;河北医科大学第三医院图书馆;
【基金】：河北省医学科学研究重点课题计划(编号:20160154)
【分类号】：R687.4

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