两种不同治疗方式治疗ACL断裂的疗效对比
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摘要
目的:比较两种不同治疗方式治疗前交叉韧带(ACL)断裂的疗效。方法:收集本院2014年9月至2018年8月63例ACL断裂患者的临床资料,根据患者治疗方法的不同,分为无减张组(41例)采取常规解剖重建和术后康复,未采取减张技术治疗;减张组(22例)采用减张技术解剖重建及术后快速康复治疗。两组患者均术后随访,并比较两组手术前后患膝屈曲度、Lysholm膝关节评分及美国特种外科医院(HSS)评分情况,记录随访期间患者并发症的发生情况。结果:63例患者术后均获随访,平均随访时间(14.05±2.25)个月。无减张组术后韧带松弛2例,关节僵硬1例;减张组术后未见并发症的发生,韧带生长状况良好。与术前相比,两组患者术后1、3个月患膝屈曲度明显升高,且减张组术后患膝屈曲度较未减张组明显升高(P<0.05)。术后3、6、12个月,两组患者Lysholm膝关节评分较术前均明显增加,且减张组术后评分较无减张组评分明显增加(P<0.05)。相比术前,两组患者术后3、6、12个月HSS评分均明显增加,且减张组术后评分较无减张组评分明显增加(P<0.05)。结论:采用减张技术解剖重建及术后快速康复治疗可有效改善ACL断裂患者术后患膝功能,促进膝关节功能恢复,且可减少并发症的发生,具有良好的安全性,有助于促进患者运动功能的恢复,其临床疗效明显优于未应用减张技术者。
Objective: To compare the efficacy of two different treatments for anterior cruciate ligament(ACL) rupture. Methods: The clinical data of 63 patients with ACL rupture in our hospital from September 2014 to August 2018 were collected. According to the different treatment methods, the patients were divided into non-tension-relieving group(41 cases) with routine anatomical reconstruction and post-operative rehabilitation, and without tension-relieving technique was used; the tension-relieving group(22 cases) with tension-relieving technique anatomical reconstruction and post-operative rapid rehabilitation treatment. The patients in both groups were followed up after operation. The knee flexion, Lysholm knee score and Hospital for Special Surgery(HSS) score before and after operation were compared between the two groups. The complications were recorded during the follow-up period. Results: All 63 patients were followed up for an average of(14.05±2.25) months. In the non-tension-relieving group, there were 2 cases of ligament relaxation and 1 case of joint stiffness. In the tension-relieving group, there was no complications and the ligament grew well. Compared with pre-operation, the knee flexion of the two groups increased significantly at 1 and 3 months after operation, and the knee flexion of the tension-relieving group was significantly higher than that of the non-tension-relieving group(P< 0.05). At 3, 6 and 12 months after operation, Lysholm knee score in both groups increased significantly compared with that before operation, and those scores in the tension-relieving group increased significantly compared with that in the non-tension-relieving group(P< 0.05). Compared with pre-operation, the HSS scores of the two groups increased significantly at 3, 6 and 12 months after operation, and the scores of the tension-relieving group increased significantly compared with those of the non-tension-relieving group(P< 0.05). Conclusion: Anatomical reconstruction with relaxation technique and rapid rehabilitation after operation can effectively improve the knee function of ACL rupture patients, promote the recovery of knee function, and reduce the occurrence of complications. It has a good safety. It is helpful to promote the recovery of patients' motor function, and its clinical effect is obviously better than that of those without tension-reducing technique.
Objective: To compare the efficacy of two different treatments for anterior cruciate ligament(ACL) rupture. Methods: The clinical data of 63 patients with ACL rupture in our hospital from September 2014 to August 2018 were collected. According to the different treatment methods, the patients were divided into non-tension-relieving group(41 cases) with routine anatomical reconstruction and post-operative rehabilitation, and without tension-relieving technique was used; the tension-relieving group(22 cases) with tension-relieving technique anatomical reconstruction and post-operative rapid rehabilitation treatment. The patients in both groups were followed up after operation. The knee flexion, Lysholm knee score and Hospital for Special Surgery(HSS) score before and after operation were compared between the two groups. The complications were recorded during the follow-up period. Results: All 63 patients were followed up for an average of(14.05±2.25) months. In the non-tension-relieving group, there were 2 cases of ligament relaxation and 1 case of joint stiffness. In the tension-relieving group, there was no complications and the ligament grew well. Compared with pre-operation, the knee flexion of the two groups increased significantly at 1 and 3 months after operation, and the knee flexion of the tension-relieving group was significantly higher than that of the non-tension-relieving group(P< 0.05). At 3, 6 and 12 months after operation, Lysholm knee score in both groups increased significantly compared with that before operation, and those scores in the tension-relieving group increased significantly compared with that in the non-tension-relieving group(P< 0.05). Compared with pre-operation, the HSS scores of the two groups increased significantly at 3, 6 and 12 months after operation, and the scores of the tension-relieving group increased significantly compared with those of the non-tension-relieving group(P< 0.05). Conclusion: Anatomical reconstruction with relaxation technique and rapid rehabilitation after operation can effectively improve the knee function of ACL rupture patients, promote the recovery of knee function, and reduce the occurrence of complications. It has a good safety. It is helpful to promote the recovery of patients' motor function, and its clinical effect is obviously better than that of those without tension-reducing technique.
引文
[1] Zeman P,Kasl J,Tupy R,et al.Evaluation of the MRI findings on a tendon graft after the anatomic anterior cruciate ligament reconstruction in patients with versus without the application of platelet-rich fibrin - results of the prospective randomised study[J].Acta Chir Orthop Traumatol Cech,2018,85(5):343～350.
[2] Michalitsis S,Vlychou M,Malizos KN,et al.Meniscal and articular cartilage lesions in the anterior cruciate ligament-deficient knee:correlation between time from injury and knee scores[J].Knee Surg Sports Traumatol Arthrosc,2015,23(1):232～239.
[3] Mueller LM,Bloomer BA,Durall CJ.Which outcome measures should be utilized to determine readiness to play after ACL reconstruction[J].Sport Rehabil,2014,23(2):158～164.
[4] Yaghmour KM,Al-Khateeb H.Anterior cruciate ligament reconstruction without the use of a tourniquet[J].Ann R Coll Surg Engl,2018,1(1):1～3.
[5] Wang W,Liu L,Chang X,et al.Cross-cultural translation of the Lysholm knee score in Chinese and its validation in patients with anterior cruciate ligament injury[J].BMC Musculoskelet Disord,2016,17(1):436.
[6] Mccarthy M,Mallett K,Abola M,et al.Hospital for Special Surgery ACL registry:2-year outcomes suggest low revision and return to OR rates[J].HSS J,2017,13(2):119～127.
[7] 滕群群,董晓艳,魏民,等.ACL重建术后引流放置效果的临床观察及护理[J].河北医学,2016,22(7):1189～1192.
[8] Ariel de Lima D,Helito CP,Lima FRA,et al.Surgical indications for anterior cruciate ligament reconstruction combined with extra-articular lateral tenodesis or anterolateral ligament reconstruction[J].Rev Bras Ortop,2018,53(6):661～667.
[9] Selim NM.Anatomic double-bundle anterior cruciate ligament reconstruction with hamstring tendon autograft through single femoral tunnel and single branched tibial tunnel[J].Arthrosc Tech,2018,7(10):e989～e998.
[10] Packer JD,Bedi A,Fox AJ,et al.Effect of immediate and delayed high-strain loading on tendon-to-bone healing after anterior cruciate ligament reconstruction[J].Bone Joint Surg Am,2014,96(9):770～777.
[11] 刘书芳,矫玮,张晓辉.不同康复方案对前交叉韧带重建术后运动员骨隧道的影响[J].中国运动医学杂志,2016,35(2):141～146,125.
[12] Cronstrom A.Is poor proprioception associated with worse movement quality of the knee in individuals with anterior cruciate ligament deficiency or reconstruction[J].Phys Ther Sci,2018,30(10):1278～1283
[2] Michalitsis S,Vlychou M,Malizos KN,et al.Meniscal and articular cartilage lesions in the anterior cruciate ligament-deficient knee:correlation between time from injury and knee scores[J].Knee Surg Sports Traumatol Arthrosc,2015,23(1):232～239.
[3] Mueller LM,Bloomer BA,Durall CJ.Which outcome measures should be utilized to determine readiness to play after ACL reconstruction[J].Sport Rehabil,2014,23(2):158～164.
[4] Yaghmour KM,Al-Khateeb H.Anterior cruciate ligament reconstruction without the use of a tourniquet[J].Ann R Coll Surg Engl,2018,1(1):1～3.
[5] Wang W,Liu L,Chang X,et al.Cross-cultural translation of the Lysholm knee score in Chinese and its validation in patients with anterior cruciate ligament injury[J].BMC Musculoskelet Disord,2016,17(1):436.
[6] Mccarthy M,Mallett K,Abola M,et al.Hospital for Special Surgery ACL registry:2-year outcomes suggest low revision and return to OR rates[J].HSS J,2017,13(2):119～127.
[7] 滕群群,董晓艳,魏民,等.ACL重建术后引流放置效果的临床观察及护理[J].河北医学,2016,22(7):1189～1192.
[8] Ariel de Lima D,Helito CP,Lima FRA,et al.Surgical indications for anterior cruciate ligament reconstruction combined with extra-articular lateral tenodesis or anterolateral ligament reconstruction[J].Rev Bras Ortop,2018,53(6):661～667.
[9] Selim NM.Anatomic double-bundle anterior cruciate ligament reconstruction with hamstring tendon autograft through single femoral tunnel and single branched tibial tunnel[J].Arthrosc Tech,2018,7(10):e989～e998.
[10] Packer JD,Bedi A,Fox AJ,et al.Effect of immediate and delayed high-strain loading on tendon-to-bone healing after anterior cruciate ligament reconstruction[J].Bone Joint Surg Am,2014,96(9):770～777.
[11] 刘书芳,矫玮,张晓辉.不同康复方案对前交叉韧带重建术后运动员骨隧道的影响[J].中国运动医学杂志,2016,35(2):141～146,125.
[12] Cronstrom A.Is poor proprioception associated with worse movement quality of the knee in individuals with anterior cruciate ligament deficiency or reconstruction[J].Phys Ther Sci,2018,30(10):1278～1283