前交叉韧带保留残端重建对患者术后膝关节本体感觉功能恢复的影响
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摘要
目的:研究前交叉韧带保留残端重建对患者术后膝关节本体感觉功能恢复的影响。方法:选取2014年3月-2016年3月于我院行膝关节镜下前交叉韧带重建手术患者108例,采用随机数字表法将所有患者分为对照组(n=54)和研究组(n=54)。对照组给予非保留残端重建治疗,研究组给予保留残端重建治疗,两组患者均进行为期12个月的随访观察。分别比较两组患者术前、术后3个月、术后6个月、术后12个月膝关节功能以及本体感觉功能恢复情况。结果:术前、术后12个月两组患者膝关节Lysholm评分对比均无统计学差异(P>0.05),术后3个月、术后6个月研究组膝关节Lysholm评分明显高于对照组,差异有统计学意义(P<0.05)。术后各个时间两组患者膝关节Lysholm评分均高于术前,且随着时间的推移呈上升的趋势,差异有统计学意义(P<0.05)。术前、术后12个月两组膝关节被动活动察觉阈值、被动角度再生试验结果对比无统计学差异(P>0.05),术后3个月、术后6个月研究组的膝关节被动活动察觉阈值、被动角度再生试验结果明显低于对照组,差异有统计学意义(P<0.05),术后各个时间两组患者膝关节被动活动察觉阈值、被动角度再生试验结果均低于术前,且随着时间的推移呈下降的趋势,差异有统计学意义(P<0.05)。两组患者不良反应发生率均为1.85%,无统计学差异(P>0.05)。结论:前交叉韧带保留残端重建有利于患者术后膝关节功能以及本体感觉功能早期恢复,安全性好,值得临床推广。
Objective: To study the effect of reconstruction of anterior cruciate ligament stump on the recovery of proprioceptive function of knee joint after operation. Methods: A total of 108 patients,who underwent arthroscopic reconstruction of anterior cruciate ligament stump in Cangzhou Hospital of Integrated TCM and Western Medicine of Hebei Province from March 2014 to March 2016,were selected and were randomly divided into study group(n=54) and control group(n=54). The control group was given non reserved stump reconstruction treatment, and the study group was given retained stump reconstruction treatment. The patients of the two groups were followed-up for 12 months. The function of knee joint and the recovery of proprioceptive function were compared between the two groups before operation, 3 months, 6 months and 12 months after operation. Results: There was no significant difference in Lysholm score between the two groups before operation and 12 months after operation(P>0.05). The Lysholm score of the knee joint of the study group was significantly higher than that of the control group 3 months and 6 months after operation, and the difference was statistically significant(P<0.05). The Lysholm score of knee joint in the two groups was higher than that before operation and after operation, and the trend increased with the time, the difference was statistically significant(P <0.05). There weres no statistical difference in the motion detection threshold and passive angle regeneration test before operation and 12 months after operation between the two groups(P>0.05).The passive motion detection threshold and passive angle regeneration test in the study group 3 months and 6 months after operation were significantly lower than those in the control group, the difference was statistically significant(P <0.05). After operation, the passive motion detection threshold and passive angle regeneration test results of the two groups were all lower than those before operation,decreasing with the time, the difference was statistically significant(P<0.05). The incidence of adverse reactions in the two groups was1.85%, with no statistical difference(P>0.05). Conclusion: The reconstruction of the anterior cruciate ligament with retained residual end is beneficial to the postoperative recovery of the function of the knee joint and the function of proprioception, with good safety, which is worthy of clinical promotion.
Objective: To study the effect of reconstruction of anterior cruciate ligament stump on the recovery of proprioceptive function of knee joint after operation. Methods: A total of 108 patients,who underwent arthroscopic reconstruction of anterior cruciate ligament stump in Cangzhou Hospital of Integrated TCM and Western Medicine of Hebei Province from March 2014 to March 2016,were selected and were randomly divided into study group(n=54) and control group(n=54). The control group was given non reserved stump reconstruction treatment, and the study group was given retained stump reconstruction treatment. The patients of the two groups were followed-up for 12 months. The function of knee joint and the recovery of proprioceptive function were compared between the two groups before operation, 3 months, 6 months and 12 months after operation. Results: There was no significant difference in Lysholm score between the two groups before operation and 12 months after operation(P>0.05). The Lysholm score of the knee joint of the study group was significantly higher than that of the control group 3 months and 6 months after operation, and the difference was statistically significant(P<0.05). The Lysholm score of knee joint in the two groups was higher than that before operation and after operation, and the trend increased with the time, the difference was statistically significant(P <0.05). There weres no statistical difference in the motion detection threshold and passive angle regeneration test before operation and 12 months after operation between the two groups(P>0.05).The passive motion detection threshold and passive angle regeneration test in the study group 3 months and 6 months after operation were significantly lower than those in the control group, the difference was statistically significant(P <0.05). After operation, the passive motion detection threshold and passive angle regeneration test results of the two groups were all lower than those before operation,decreasing with the time, the difference was statistically significant(P<0.05). The incidence of adverse reactions in the two groups was1.85%, with no statistical difference(P>0.05). Conclusion: The reconstruction of the anterior cruciate ligament with retained residual end is beneficial to the postoperative recovery of the function of the knee joint and the function of proprioception, with good safety, which is worthy of clinical promotion.
引文
[1]Ranuccio F,Familiari F,Tedesco G,et al.Effects of Notchplasty on Anterior Cruciate Ligament Reconstruction:A Systematic Review[J]Joints,2017,5(3):173-179
[2]Almazán-Díaz A,Sierra-Suárez L,Cruz-López F,et al.Intraarticular lesions associated with tibial fixation during anterior cruciate ligament reconstruction[J].Acta Ortop Mex,2017,31(3):145-147
[3]Ho SW,Lee KT.A Rare Case of Intra-Articular Displacement of EndoButton Following Anterior Cruciate Ligament Reconstruction[J].Clin Orthop Surg,2017,9(4):534-536
[4]Satora W,Królikowska A,Czamara A,et al.Synthetic grafts in the treatment of ruptured anterior cruciate ligament of the knee joint[J]Polim Med,2017,47(1):55-59
[5]Pinczewski LA,Salmon LJ.Editorial Commentary:The Acrid Bioscrew in Anterior Cruciate Ligament Reconstruction of the Knee[J].Arthroscopy,2017,33(12):2195-2197
[6]De Phillipo NN,Cinque ME,Chahla J,et al.Incidence and Detection of Meniscal Ramp Lesions on Magnetic Resonance Imaging in Patients With Anterior Cruciate Ligament Reconstruction[J].Am JSports Med,2017,45(10):2233-2237
[7]孔颖,王雷,张元民,等.关节镜下保留残端自体腘绳肌腱同期单束重建前后交叉韧带疗效观察[J].中国矫形外科杂志,2015,23(2):113-118Kong Ying,Wang Lei,Zhang Yuan-min,et al.Arthroscopic anterior and posterior cruciate ligament single-bundle reconstruction using hamstring tendon auto-grafts with remnant preservation[J].Orthopedic Journal of China,2015,23(2):113-118
[8]Kim HJ,Lee JH,Lee DH.Proprioception in Patients With Anterior Cruciate Ligament Tears:A Meta-analysis Comparing Injured and Uninjured Limbs[J].Am J Sports Med,2017,45(12):2916-2922
[9]Li J,Kong F,Gao X,et al.Prospective Randomized Comparison of Knee Stability and Proprioception for Posterior Cruciate Ligament Reconstruction With Autograft,Hybrid Graft,andγ-Irradiated Allograft[J].Arthroscopy,2016,32(12):2548-2555
[10]Wei M,Liu Y,Li Z,et al.Short-term effects of radiofrequency shrinkage treatment for anterior cruciate ligament relaxation on proprioception[J].J Int Med Res,2013,41(5):1586-1593
[11]Lee DH,Lee JH,Ahn SE,et al.Effect of Time after Anterior Cruciate Ligament Tears on Proprioception and Postural Stability[J].PLo SOne,2015,10(9):e0139038
[12]Mir SM,Talebian S,Naseri N,et al.Assessment of Knee Proprioception in the Anterior Cruciate Ligament Injury Risk Position in Healthy Subjects:A Cross-sectional Study[J].J Phys Ther Sci,2014,26(10):1515-1518
[13]Nagai T,Heebner NR,Sell TC,et al.Restoration of sagittal and transverse plane proprioception following anatomic double-bundle ACL reconstruction[J].Knee Surg Sports Traumatol Arthrosc,2013,21(9):2048-2056
[14]Dingenen B,Janssens L,Luyckx T,et al.Postural stability during the transition from double-leg stance to single-leg stance in anterior cruciate ligament injured subjects[J].Clin Biomech(Bristol,Avon),2015,30(3):283-289
[15]胡喜春,黄长明,范华强,等.关节镜下前交叉韧带重建中保留残端对膝关节功能及本体感觉恢复的影响研究[J].现代生物医学进展,2017,17(26):5062-5065,5095Hu Xi-chun,Huang Chang-ming,Fan Hua-qiang,et al.Effect of Remnant Preservation on Knee Joint Function and Proprioception Recovery in Anterior Cruciate Ligament Reconstruction under Arthroscope[J].Progress in Modern Biomedicine,2017,17(26):5062-5065,5095
[16]Cho HJ,Kim TK,Kang SB,et al.Variations in sagittal locations of anterior cruciate ligament tibial footprints and their association with radiographic landmarks:a human cadaveric study[J].BMCMusculoskelet Disord,2017,18(1):448-449
[17]Soejima T,Kanazawa T,Tabuchi K,et al.Regeneration of ringshaped lateral meniscus after partial resection of discoid meniscus with anterior cruciate ligament reconstruction[J].Int J Surg Case Rep,2013,4(12):1093-1096
[18]Makhni EC,Crump EK,Steinhaus ME,et al.Quality and Variability of Online Available Physical Therapy Protocols From Academic Orthopaedic Surgery Programs for Anterior Cruciate Ligament Reconstruction[J].Arthroscopy,2016,32(8):1612-1621
[19]张磊,孙荣鑫,王少军,等.保留残端重建兔前交叉韧带术对其胫骨骨道扩大的预防作用[J].山东医药,2016,56(37):25-27Zhang Lei,Sun Rong-xin,Wang Shao-jun,et al.The preventive effect of reconstruction of rabbit anterior cruciate ligament with retained stump on the enlargement of the bone canal of the tibia[J].Shandong Medical Journal,2016,56(37):25-27
[20]Gupta R,Bahadur R,Malhotra A,et al.Anterior Cruciate Ligament Reconstruction Using Hamstring Tendon Autograft With Preserved Insertions[J].Arthrosc Tech,2016,5(2):e269-e274
[21]张太良,张磊,廉志明,等.关节镜下前交叉韧带重建保留残端与否干预膝关节本体感觉功能恢复的Meta分析[J].中国组织工程研究,2017,21(03):471-477Zhang Tai-liang,Zhang Lei,Lian Zhi-ming,et al.Effect of remnant preservation on recovery of knee proprioception in arthroscopic anterior cruciate ligament reconstruction:a meta-analysis[J].Chinese Journal of Tissue Engineering Research,2017,21(03):471-477
[22]Andonovski A,Topuzovska S,Samardziski M,et al.The Influence of Anterior Cruciate Ligament Remnant on Postoperative Clinical Results in Patients with Remnant Preserving Anterior Cruciate Ligament Reconstruction[J].Open Access Maced J Med Sci,2017,5(5):624-629
[23]Nag HL,Gupta H.Anterior cruciate ligament reconstruction with preservation of femoral anterior cruciate ligament stump[J].Arthrosc Tech,2014,3(5):e575-e577
[24]Plotkin BE,Agarwal VK,Varma R.Stump Entrapment of the Torn Anterior Cruciate Ligament[J].Radiol Case Rep,2016,4(1):268
[25]Faltstrom A,Hagglund M,Kvist J.Functional Performance Among Active Female Soccer Players After Unilateral Primary Anterior Cruciate Ligament Reconstruction Compared With Knee-Healthy Controls[J].Am J Sports Med,2017,45(2):377-385
[26]Hajizadeh M,Hashemi Oskouei A,Ghalichi F,et al.Knee Kinematics and Joint Moments During Stair Negotiation in Participants with Anterior Cruciate Ligament Deficiency and Reconstruction:A Systematic Review and Meta-Analysis[J].PM R,2016,8(6):563-579.e1
[27]Noh JH,Yoon KH,Song SJ,et al.Re-tensioning technique to cover the graft with remnant in anterior cruciate ligament reconstruction[J].Arthrosc Tech,2014,3(6):e679-e682
[28]王刚,杨自权,曹万全,等.保留残端重建对膝关节本体感觉恢复的影响[J].中华临床医师杂志(电子版),2017,11(03):475-478Wang Gang,Yang Zi-quan,Cao Wan-quan,et al.Effects of remnants preservation on proprioception recovery after anterior cruciate ligament reconstruction[J].Chinese Journal of Clinicians(Electronic Edition),2017,11(03):475-478
[29]Cho SH,Bae CH,Gak HB.Effects of closed kinetic chain exercises on proprioception and functional scores of the knee after anterior cruciate ligament reconstruction[J].J Phys Ther Sci,2013,25(10):1239-1241
[30]Hu J,Qu J,Xu D,et al.Clinical outcomes of remnant preserving augmentation in anterior cruciate ligament reconstruction:a systematic review[J].Knee Surg Sports Traumatol Arthrosc,2014,22(9):1976-1985
[2]Almazán-Díaz A,Sierra-Suárez L,Cruz-López F,et al.Intraarticular lesions associated with tibial fixation during anterior cruciate ligament reconstruction[J].Acta Ortop Mex,2017,31(3):145-147
[3]Ho SW,Lee KT.A Rare Case of Intra-Articular Displacement of EndoButton Following Anterior Cruciate Ligament Reconstruction[J].Clin Orthop Surg,2017,9(4):534-536
[4]Satora W,Królikowska A,Czamara A,et al.Synthetic grafts in the treatment of ruptured anterior cruciate ligament of the knee joint[J]Polim Med,2017,47(1):55-59
[5]Pinczewski LA,Salmon LJ.Editorial Commentary:The Acrid Bioscrew in Anterior Cruciate Ligament Reconstruction of the Knee[J].Arthroscopy,2017,33(12):2195-2197
[6]De Phillipo NN,Cinque ME,Chahla J,et al.Incidence and Detection of Meniscal Ramp Lesions on Magnetic Resonance Imaging in Patients With Anterior Cruciate Ligament Reconstruction[J].Am JSports Med,2017,45(10):2233-2237
[7]孔颖,王雷,张元民,等.关节镜下保留残端自体腘绳肌腱同期单束重建前后交叉韧带疗效观察[J].中国矫形外科杂志,2015,23(2):113-118Kong Ying,Wang Lei,Zhang Yuan-min,et al.Arthroscopic anterior and posterior cruciate ligament single-bundle reconstruction using hamstring tendon auto-grafts with remnant preservation[J].Orthopedic Journal of China,2015,23(2):113-118
[8]Kim HJ,Lee JH,Lee DH.Proprioception in Patients With Anterior Cruciate Ligament Tears:A Meta-analysis Comparing Injured and Uninjured Limbs[J].Am J Sports Med,2017,45(12):2916-2922
[9]Li J,Kong F,Gao X,et al.Prospective Randomized Comparison of Knee Stability and Proprioception for Posterior Cruciate Ligament Reconstruction With Autograft,Hybrid Graft,andγ-Irradiated Allograft[J].Arthroscopy,2016,32(12):2548-2555
[10]Wei M,Liu Y,Li Z,et al.Short-term effects of radiofrequency shrinkage treatment for anterior cruciate ligament relaxation on proprioception[J].J Int Med Res,2013,41(5):1586-1593
[11]Lee DH,Lee JH,Ahn SE,et al.Effect of Time after Anterior Cruciate Ligament Tears on Proprioception and Postural Stability[J].PLo SOne,2015,10(9):e0139038
[12]Mir SM,Talebian S,Naseri N,et al.Assessment of Knee Proprioception in the Anterior Cruciate Ligament Injury Risk Position in Healthy Subjects:A Cross-sectional Study[J].J Phys Ther Sci,2014,26(10):1515-1518
[13]Nagai T,Heebner NR,Sell TC,et al.Restoration of sagittal and transverse plane proprioception following anatomic double-bundle ACL reconstruction[J].Knee Surg Sports Traumatol Arthrosc,2013,21(9):2048-2056
[14]Dingenen B,Janssens L,Luyckx T,et al.Postural stability during the transition from double-leg stance to single-leg stance in anterior cruciate ligament injured subjects[J].Clin Biomech(Bristol,Avon),2015,30(3):283-289
[15]胡喜春,黄长明,范华强,等.关节镜下前交叉韧带重建中保留残端对膝关节功能及本体感觉恢复的影响研究[J].现代生物医学进展,2017,17(26):5062-5065,5095Hu Xi-chun,Huang Chang-ming,Fan Hua-qiang,et al.Effect of Remnant Preservation on Knee Joint Function and Proprioception Recovery in Anterior Cruciate Ligament Reconstruction under Arthroscope[J].Progress in Modern Biomedicine,2017,17(26):5062-5065,5095
[16]Cho HJ,Kim TK,Kang SB,et al.Variations in sagittal locations of anterior cruciate ligament tibial footprints and their association with radiographic landmarks:a human cadaveric study[J].BMCMusculoskelet Disord,2017,18(1):448-449
[17]Soejima T,Kanazawa T,Tabuchi K,et al.Regeneration of ringshaped lateral meniscus after partial resection of discoid meniscus with anterior cruciate ligament reconstruction[J].Int J Surg Case Rep,2013,4(12):1093-1096
[18]Makhni EC,Crump EK,Steinhaus ME,et al.Quality and Variability of Online Available Physical Therapy Protocols From Academic Orthopaedic Surgery Programs for Anterior Cruciate Ligament Reconstruction[J].Arthroscopy,2016,32(8):1612-1621
[19]张磊,孙荣鑫,王少军,等.保留残端重建兔前交叉韧带术对其胫骨骨道扩大的预防作用[J].山东医药,2016,56(37):25-27Zhang Lei,Sun Rong-xin,Wang Shao-jun,et al.The preventive effect of reconstruction of rabbit anterior cruciate ligament with retained stump on the enlargement of the bone canal of the tibia[J].Shandong Medical Journal,2016,56(37):25-27
[20]Gupta R,Bahadur R,Malhotra A,et al.Anterior Cruciate Ligament Reconstruction Using Hamstring Tendon Autograft With Preserved Insertions[J].Arthrosc Tech,2016,5(2):e269-e274
[21]张太良,张磊,廉志明,等.关节镜下前交叉韧带重建保留残端与否干预膝关节本体感觉功能恢复的Meta分析[J].中国组织工程研究,2017,21(03):471-477Zhang Tai-liang,Zhang Lei,Lian Zhi-ming,et al.Effect of remnant preservation on recovery of knee proprioception in arthroscopic anterior cruciate ligament reconstruction:a meta-analysis[J].Chinese Journal of Tissue Engineering Research,2017,21(03):471-477
[22]Andonovski A,Topuzovska S,Samardziski M,et al.The Influence of Anterior Cruciate Ligament Remnant on Postoperative Clinical Results in Patients with Remnant Preserving Anterior Cruciate Ligament Reconstruction[J].Open Access Maced J Med Sci,2017,5(5):624-629
[23]Nag HL,Gupta H.Anterior cruciate ligament reconstruction with preservation of femoral anterior cruciate ligament stump[J].Arthrosc Tech,2014,3(5):e575-e577
[24]Plotkin BE,Agarwal VK,Varma R.Stump Entrapment of the Torn Anterior Cruciate Ligament[J].Radiol Case Rep,2016,4(1):268
[25]Faltstrom A,Hagglund M,Kvist J.Functional Performance Among Active Female Soccer Players After Unilateral Primary Anterior Cruciate Ligament Reconstruction Compared With Knee-Healthy Controls[J].Am J Sports Med,2017,45(2):377-385
[26]Hajizadeh M,Hashemi Oskouei A,Ghalichi F,et al.Knee Kinematics and Joint Moments During Stair Negotiation in Participants with Anterior Cruciate Ligament Deficiency and Reconstruction:A Systematic Review and Meta-Analysis[J].PM R,2016,8(6):563-579.e1
[27]Noh JH,Yoon KH,Song SJ,et al.Re-tensioning technique to cover the graft with remnant in anterior cruciate ligament reconstruction[J].Arthrosc Tech,2014,3(6):e679-e682
[28]王刚,杨自权,曹万全,等.保留残端重建对膝关节本体感觉恢复的影响[J].中华临床医师杂志(电子版),2017,11(03):475-478Wang Gang,Yang Zi-quan,Cao Wan-quan,et al.Effects of remnants preservation on proprioception recovery after anterior cruciate ligament reconstruction[J].Chinese Journal of Clinicians(Electronic Edition),2017,11(03):475-478
[29]Cho SH,Bae CH,Gak HB.Effects of closed kinetic chain exercises on proprioception and functional scores of the knee after anterior cruciate ligament reconstruction[J].J Phys Ther Sci,2013,25(10):1239-1241
[30]Hu J,Qu J,Xu D,et al.Clinical outcomes of remnant preserving augmentation in anterior cruciate ligament reconstruction:a systematic review[J].Knee Surg Sports Traumatol Arthrosc,2014,22(9):1976-1985