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关节镜下自体腘绳肌腱与锚钉缝线带强化重建前交叉韧带

[Arthroscopic reinforced reconstruction of anterior cruciate ligament with autologous hamstring tendon and anchor suture band].

作者信息

Zhang Yanjie, Wang Xiao, Li Jichao, Huang Xiaohan

机构信息

Department of Knee Surgery, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang Henan, 471002, P.R.China.

出版信息

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2021 Feb 15;35(2):171-177. doi: 10.7507/1002-1892.202008123.

Abstract

OBJECTIVE

To investigate the effectiveness of arthroscopic reinforced reconstruction of anterior cruciate ligament (ACL) with autologous hamstring tendon combined with anchor suture band.

METHODS

Between February 2016 and March 2018, 60 patients who were to be treated with arthroscopic ACL reconstruction and met the selection criteria were selected in the study. Among them, 30 cases were reconstructed with autologous hamstring tendon combined with anchor suture band (trial group), and 30 cases were reconstructed with simple autologous hamstring tendon (control group). There was no significant difference in gender, age, disease duration, cause of injury, injury side, and preoperative Lysholm score, Tegner score, and International Knee Documentation Committee (IKDC) score between the two groups ( >0.05). After reconstruction, the patients in the trial group were allowed to start knee flexion and extension activities early without wearing an adjustable brace, while the patients in the control group were required to wear an adjustable brace for 12 weeks. The knee joint function (Lysholm score, Tegner score, IKDC score) and stability (Lachman test and pivot shift test) were compared between the two groups after operation.

RESULTS

There was no significant difference in graft diameter between the two groups ( =1.061, =0.115). Compared with the control group, the operation time of the trial group was significantly different ( =4.924, =0.000). All incisions healed primarily. In the control group, the intramuscular venous thrombosis occurred in 2 cases after operation. Both groups were followed up 18 months. The Lysholm score, Tegner score, and IKDC score of the two groups at each time point after operation were significantly higher than those before operation ( <0.05); the above scores in the trial group were significantly higher than those in the control group at 3, 6, and 9 months after operation ( <0.05); there was no significant difference between the two groups at 18 months after operation ( >0.05). There was no significant difference in Lachman test results between the two groups at each time point after operation ( >0.05). There was a significant difference in pivot shift test results at 6 months after operation between the two groups ( <0.05); but there was no significant difference at other time points ( >0.05).

CONCLUSION

The effectiveness of ACL reinforcedreconstruction with autologous hamstring tendon combined with anchor suture band is satisfactory. Compared with using autologous hamstring tendon alone, it has better initial strength and joint stability, and is more conducive to early postoperative functional exercise and functional recovery of knee joint.

摘要

目的

探讨关节镜下自体腘绳肌腱联合锚钉缝合带强化重建前交叉韧带(ACL)的有效性。

方法

选取2016年2月至2018年3月间拟行关节镜下ACL重建且符合入选标准的60例患者。其中,30例采用自体腘绳肌腱联合锚钉缝合带进行重建(试验组),30例采用单纯自体腘绳肌腱进行重建(对照组)。两组患者在性别、年龄、病程、损伤原因、损伤侧别以及术前Lysholm评分、Tegner评分和国际膝关节文献委员会(IKDC)评分方面比较,差异均无统计学意义(P>0.05)。重建后,试验组患者术后早期即可开始膝关节屈伸活动,无需佩戴可调式支具,而对照组患者需佩戴可调式支具12周。比较两组患者术后膝关节功能(Lysholm评分、Tegner评分、IKDC评分)及稳定性(Lachman试验和轴移试验)。

结果

两组移植物直径比较,差异无统计学意义(t=1.061,P=0.115)。试验组与对照组手术时间比较,差异有统计学意义(t=4.924,P=0.000)。所有切口均一期愈合。对照组术后有2例发生肌内静脉血栓形成。两组均随访18个月。两组术后各时间点的Lysholm评分、Tegner评分和IKDC评分均显著高于术前(P<0.05);试验组术后3、6、9个月上述评分显著高于对照组(P<0.05);术后18个月两组比较,差异无统计学意义(P>0.05)。两组术后各时间点Lachman试验结果比较,差异无统计学意义(P>0.05)。两组术后6个月轴移试验结果比较,差异有统计学意义(P<0.05);其他时间点差异无统计学意义(P>0.05)。

结论

自体腘绳肌腱联合锚钉缝合带强化重建ACL的效果满意。与单纯使用自体腘绳肌腱相比,其初始强度和关节稳定性更好,更有利于术后早期功能锻炼及膝关节功能恢复。

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