摘要
目的:比较保残重建和非保残解剖重建两种方式治疗"后交叉韧带愈合"型前交叉韧带损伤的短期临床效果。方法:回顾分析2013年10月至2017年5月在国家体育总局运动医学研究所附属体育医院进行前交叉韧带(anterior cruciate ligament,ACL)重建手术的67名患者临床资料。其中保残重建组35例,术中保留ACL在后交叉韧带(posterior cruciate ligament,PCL)附着的残端,股骨止点选择解剖止点,胫骨止点选择解剖止点偏后位置进行单束重建;非保残解剖重建组32例,术中不保留附着于PCL的ACL残端,股骨胫骨骨道位置选择在解剖中心位置进行单束重建。比较两组术前术后的KT2000双膝前向松弛度差值、轴移试验、IKDC评分、Lysholm评分。结果:两组术后较术前KT2000双膝前向松弛度差值明显降低,轴移试验阴性率明显增加,IKDC评分、Lysholm评分有明显提高(P<0.05)。两组术后双膝前向松弛度差值、IKDC评分、Lysholm评分、轴移试验阴性率、轴移试验分级分布均未见显著性差异。结论:针对"PCL愈合"型的ACL损伤患者,胫骨止点偏后位置保残重建和非保残ACL解剖重建均可取得良好的术后短期疗效。
Objective To compare the short-term clinical outcomes of the remnant preservation reconstruction and anatomic reconstruction without remnant preservation for the type of posterior cruciate ligament(PCL) healing injury of anterior cruciate ligament(ACL). Methods Sixty-seven patients with PCL-healing ACL injuries were analyzed with a follow-up of 15.5 ± 4.0 months. All the subjects underwent ACL remnant preservation reconstruction(group R,n=35) or anatomic reconstruction without remnant preservation(group A,n=32). The preand post-operative anterior and rotational stability was assessed using the side-to-side difference(SSD) anterior laxity measured by KT-2000 arthrometer and pivot-shift test for both groups. The functional assessment was performed using the international knee documentation committee(IKDC) score and Lysholm questionnaire. Results In both groups,SSD anterior laxity decreased significantly(P<0.05),while the negative rate of pivot-shift test,IKDC score and Lysholm score improved significantly(P<0.05) after the operation compared with before the operation. There were no significant differences between the two groups in all the measurements after the operation.Conclusions Both the ACL remnant preservation reconstruction and anatomic reconstruction without the remnant preservation are of good short-term clinical results for patients with the PCL-healing ACL injury.
引文
[1] Offerhaus C,Albers M,Nagai K,et al. Individualizedanterior cruciate ligament graft matching:in vivo comparison of cross-sectional areas of hamstring,patellar,andquadriceps tendon grafts and ACL insertion area.Am JSports Med,2018,46(11):2646-2652.
[2]周敬滨,Zachary Working,Carola F van Eck,等.前交叉韧带解剖重建理念与方法.中国运动医学杂志,2011,30(06):511-518.
[3] Dejour D,Ntagiopoulos PG,Saggin PR,et al. The diag-nostic value of clinical tests, magnetic resonance imag-ing,and instrumented laxity in the differentiation of com-plete versus partial anterior cruciate ligament tears. Ar-throscopy,2013,29(3):491-499.
[4] Colombet P,Robinson J,Christel P,et al. Morphologyof anterior cruciate ligament attachments for anatomic re-construction:A cadaveric dissection and radiographicstudy. Arthroscopy,2006,22:984-992.
[5] Crain EH,Fithian DC,Paxton EW,et al. Variation inanterior cruciate ligament scar pattern:does the scar pat-tern affect anterior laxity in anterior cruciate ligament-de-ficient knees?. Arthroscopy,2005,21(1):19-24.
[6] Bach BR Jr, Warren RF.“Empty wall” and “verticalstrut”signs of ACL insufficiency. Arthroscopy,1989,5:137-140.
[7] Sonnery-Cottet B,Panisset JC,Colombet P,et al. Par-tial ACL reconstruction with preservation of the postero-lateral bundle. Orthop Traumatol Surg Res,2012, 98(8Suppl):S165-70.
[8] Van Eck CF,Lesniak BP,Schreiber VM,et al. Ana-tomic single-and double-bundle anterior cruciate liga-ment reconstruction flowchart. Arthroscopy, 2010, 26:258-268.
[9] Annear PT,Rohr EJ,Hille DM,et al. No clinical dif-ference in 10-year outcomes between standard and mini-mal graft debridement techniques in patients undergoinganterior cruciate ligament reconstruction using autologoushamstrings:a randomized controlled trial. Knee SurgSports Traumatol Arthrosc,2018,Sep.20.(Online).
[10] Choi S, Kim MK, Kwon YS, et al. Clinical and ar-throscopic outcome of single bundle anterior cruciate liga-ment reconstruction:Comparison of remnant preservationversus conventional technique. Knee,2017,24(5):1025-1032.
[11] Zhang Q,Zhang S,Cao X,et al. The effect of rem-nant preservation on tibial tunnel enlargement in ACL re-construction with hamstring autograft:a prospective ran-domized controlled trial. Knee Surg Sports Traumatol Ar-throsc,2014,22(1):166-173.
[12] Hong L,Li X,Zhang H,et al. Anterior cruciate liga-ment reconstruction with remnant preservation:a prospec-tive, randomized controlled study. Am J Sports Med,2012,40(12):2747-2755.
[13] Lee BI,Min KD,Choi HS,et al. Arthroscopic anterior cruciate ligament reconstruction with the tibial-remnantpreserving technique using a hamstring graft. Arthroscopy,2006,22(3):340-341.
[14] Gohil S,Annear PO,Breidahl W. Anterior cruciate liga-ment reconstruction using autologous double hamstrings:a comparison of standard versus minimal debridementtechniques using MRI to assess revascularisation. A ran-domised prospective study with a one-year follow-up. JBone Joint Surg Br,2007,89(9):1165-1171.
[15] Wang HD,Wang FS,Gao SJ,et al. Remnant preserva-tion technique versus standard technique for anterior cru-ciate ligament reconstruction:a meta-analysis of random-ized controlled trials. J Orthop Surg Res,2018,13(1):231.
[16] Gao F,Zhou J,He C,et al. A Morphologic and Quan-titative Study of Mechanoreceptors in the RemnantStump of the Human Anterior Cruciate Ligament. Arthros-copy,2016,32(2):273-280.
[17] Muneta T,Koga H,Ju YJ,et al. Remnant volume ofanterior cruciate ligament correlates preoperative patients'status and postoperative outcome. Knee Surg Sports Trau-matol Arthrosc,2013,21(4):906-913.
[18] Fu FH,van Eck CF,Tashman S,et al. Anatomic anterior cruciate ligament reconstruction:a changing para-digm. Knee Surg Sports Traumatol Arthrosc, 2015, 23(3):640-648.
[19] Mayr HO,Bruder S,Hube R,et al. Single-bundle ver-sus double-bundle anterior cruciate ligament reconstruc-tion-5-year results.Arthroscopy. 2018,34(9):2647-2653.
[20] Magnussen RA, Reinke EK, Huston LJ, et al. Effectof high-grade preoperative knee laxity on anterior cruci-ate ligament reconstruction outcomes. Am J Sports Med,2016,44(12):3077-3082.
[21] Magnussen RA, Reinke EK, Huston LJ, et al. Effectof high-grade preoperative knee laxity on 6-year anteri-or cruciate ligament reconstruction outcomes. Am JSports Med,2018,46(12):2865-2872.
[22] Ochi M,Iwasa J,Uchio Y,et al. The regeneration ofsensory neurones in the reconstruction of the anterior cru-ciate ligament. J Bone Joint Surg Br,1999,81(5):902-906.
[23] Unterhauser FN,Bail HJ,Hoher J,et al. Endoligamen-tous revascularization of an anterior cruciate ligamentgraft. Clin Orthop Relat Res,2003,414:276-288.
