不同定位方法单双束解剖重建前交叉韧带的疗效比较研究

发布时间：2018-05-26 15:34

本文选题：前交叉韧带 + 解剖重建　；参考：《中国修复重建外科杂志》2015年10期

【摘要】：目的比较采用不同定位方法行单、双束重建前交叉韧带(anterior cruciate ligament,ACL)的疗效。方法 2010年5月-2013年4月,将符合选择标准的120例ACL损伤患者纳入研究。根据手术方法不同,患者分为4组(n=30)。A组:按传统定位进行双束重建;B组:在ACL残留足迹上进行个体化解剖定位双束重建;C组:按传统定位进行单束重建;D组:在ACL残留足迹上进行个体化解剖定位单束重建。各组患者性别、年龄、病程、侧别、致伤原因及术前Lysholm评分、国际膝关节文献委员会(IKDC)分级、Lachman试验、前抽屉试验、轴移试验比较,差异均无统计学意义(P0.05),具有可比性。术后即刻行患膝MRI扫描,并建立三维模型,评定ACL移植物与股骨髁间窝是否存在撞击;采用Lachman试验、前抽屉试验、轴移试验以及Lysholm评分、IKDC分级比较组间疗效差异。结果三维模型分析显示:A组11例(36.7%)出现撞击,B组1例(3.3%),C组9例(30.0%),D组无撞击发生。其中,A、C组撞击发生率显著高于B、D组,比较差异有统计学意义(P0.05);A、C组间及B、D组间比较,差异无统计学意义(P0.05)。4组患者术后切口均Ⅰ期愈合,无早期相关并发症发生。患者均获随访,随访时间24~30个月,平均26个月。术后24个月4组Lysholm评分、Lachman试验、前抽屉试验及轴移试验比较,差异均无统计学意义(P0.05);组内术后均显著优于术前,差异有统计学意义(P0.05)。术后24个月IKDC分级比较,B、D组显著优于A、C组,比较差异有统计学意义(P0.05);A、C组间及B、D组间比较,差异均无统计学意义(P0.05)。结论与传统定位方法相比,按残留足迹进行个体化解剖定位单、双束重建ACL均可降低术后撞击发生率,膝关节功能恢复更好。
[Abstract]:Objective to compare the effect of single and double bundle reconstruction of anterior cruciate ligamentus (ACL) with different localization methods. Methods from May 2010 to April 2013, 120 patients with ACL injury who met the selection criteria were included in the study. Depending on the operation, The patients were divided into 4 groups: group A: double bundle reconstruction group B: group C: group D: on residual footprint of ACL: group B: group C: group D: performed on residual footprint of ACL: group C: group C Single bundle reconstruction of anatomical localization. Gender, age, course of disease, side difference, cause of injury and preoperative Lysholm score, ISCC grade Lachman test, anterior drawer test and axial shift test showed no statistical significance. MRI scan of the affected knee was performed immediately after operation, and a three-dimensional model was established to evaluate whether there was an impact between the ACL graft and the femoral intercondylar fossa. The difference of curative effect between the groups was compared by Lachman test, anterior drawer test, axial shift test and Lysholm score. Results Three-dimensional model analysis showed that there was no impact in group B (n = 11, n = 11) and group B (n = 1). There was no impact in group C (n = 9) and group D (n = 9). The incidence of impact in group C was significantly higher than that in group B (P 0.05), and there was no significant difference between group A (P 0.05) and group B (D). There was no significant difference between group A (P 0.05) and group B (P 0.05). There were no early complications associated with early wound healing in group P0.054.The incidence of impact in group A was significantly higher than that in group B (P 0.05). All patients were followed up for 24 ~ 30 months (mean 26 months). 24 months after operation, there was no significant difference in Lysholm scores, anterior drawer test and axial shift test among the four groups, but there was significant difference between the four groups after operation (P 0.05). 24 months after operation, the IKDC grade in group D was significantly better than that in group A (P 0.05) and there was no significant difference between group B (P 0.05) and group D (P 0.05). Conclusion compared with the traditional localization method, individualized anatomical localization with residual footprint and double bundle reconstruction ACL can reduce the incidence of postoperative impact and improve the function of knee joint.
【作者单位】：昆明医科大学第一附属医院运动医学科;
【基金】：云南省创新团队项目(2014HC018) 云南省国际合作项目(2013IA004) 云南省医学学科带头人培养项目(D-201207)~~
【分类号】：R873

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