前交叉韧带重建胫骨栓桩与挤压螺钉固定的比较
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摘要
[目的]评估膝关节前交叉韧带损伤胫骨栓桩固定及可吸收挤压钉固定的疗效。[方法] 2011～2016年治疗膝关节前交叉韧带损伤患者61例,股骨骨道均以Endobutton固定,其中胫骨骨道栓桩固定25例,胫骨骨道可吸收挤压钉固定36例,手术前后行Lachman试验、IKDC和Lysholm评分,以评估手术疗效。[结果] 61例患者均顺利接受手术,术中无血管神经损伤等严重并发症。术后栓桩组平均随访(13.62±1.23)个月,挤压钉组随访(14.72±1.16)个月。末次随访时栓柱钉组25例患者和挤压钉组36例患者均无明显疼痛、交锁和打软腿症状,前抽屉试验、轴移试验及Lachman试验均为阴性。两组的ROM均随时间延长有所增加,但差异无统计学意义(P>0.05),不同时间点两组间ROM的差异均无统计学意义(P<0.05)。术后6、12个月时两组的KT-1000值均较术前显著减少,差异有统计学意义(P<0.05),而两组术后6个月与12个月的KT-1000值差异均无统计学意义(P>0.05)。相同时间点两组间KT-1000值的差异均无统计学意义(P>0.05)。随着时间延长,两组患者的Lysholm评分和IKDC 2000评分均显著增加,两组患者不同时间点的差异均有统计学意义(P<0.05),但相同时间点两组间Lysholm评分和IKDC2000评分的差异均无统计学意义(P>0.05)。[结论]前交叉韧带重建胫骨骨道可吸收挤压螺钉固定与皮质骨螺钉栓桩固定术后均取得较好疗效,两组相比较无明显差别,胫骨侧栓桩固定也是一种可靠的固定方法。
[Objective] To compared the clinical outcomes of screw post versus absorbable interference screw for graft fixation at tibia end in anterior cruciate ligament(ACL) reconstruction. [Methods] A total of 61 patients with ACL tear were surgically treated from 2011 to 2016. During ACL reconstruction, cortical femoral suspensory fixation was used with Endobutton in all patients, while cortical tibial suspensory fixation with screw post was applied in 25 patients(the screw post group), by contrast, absorbable interference screw fixation used in the remaining 36 patients(the interference screw group). The Lachman test,KT-1000, Lysholm and IKDC scores were performed before and after surgery to evaluate the consequences. [Results] All the patients had operation done smoothly without serious complication, such as neurovascular injuries. The patients in the screw post group were followed up for an average of(13.62±1.23) months, while those in the interference screw group followed up for(14.72±1.16) months. At the latest follow up, all patients, including 25 patients in the screw post group and 36 patients in the interference screw group, were free from symptoms, such as pain, locking and giving way, associated with negative anterior drawer, pivot shift and Lachman tests. The flexion-extension range of motion increased over time in both group despite no statistical differences between the two groups at any corresponding time points(P>0.05). The side to side differences of KT-1000 knee ligament arthrometer at 6 and 12 months postoperatively were significantly less than those before operation in both group(P<0.05), although no statistical differences were noticed at any corresponding time points between the two groups(P>0.05). As time elapsed, both Lysholm score and IKDC 2000 score significantly increased in the two groups(P<0.05), but no statistical differences were proved in Lysholm score or IKDC 2000 score between the two groups at any corresponding time points(P>0.05).[Conclusion] This result demonstrates that both tibial cortical suspensory fixation with screw post and interference screw tibia fixation achieve similar satisfactory clinical outcomes for ACL reconstruction.
[Objective] To compared the clinical outcomes of screw post versus absorbable interference screw for graft fixation at tibia end in anterior cruciate ligament(ACL) reconstruction. [Methods] A total of 61 patients with ACL tear were surgically treated from 2011 to 2016. During ACL reconstruction, cortical femoral suspensory fixation was used with Endobutton in all patients, while cortical tibial suspensory fixation with screw post was applied in 25 patients(the screw post group), by contrast, absorbable interference screw fixation used in the remaining 36 patients(the interference screw group). The Lachman test,KT-1000, Lysholm and IKDC scores were performed before and after surgery to evaluate the consequences. [Results] All the patients had operation done smoothly without serious complication, such as neurovascular injuries. The patients in the screw post group were followed up for an average of(13.62±1.23) months, while those in the interference screw group followed up for(14.72±1.16) months. At the latest follow up, all patients, including 25 patients in the screw post group and 36 patients in the interference screw group, were free from symptoms, such as pain, locking and giving way, associated with negative anterior drawer, pivot shift and Lachman tests. The flexion-extension range of motion increased over time in both group despite no statistical differences between the two groups at any corresponding time points(P>0.05). The side to side differences of KT-1000 knee ligament arthrometer at 6 and 12 months postoperatively were significantly less than those before operation in both group(P<0.05), although no statistical differences were noticed at any corresponding time points between the two groups(P>0.05). As time elapsed, both Lysholm score and IKDC 2000 score significantly increased in the two groups(P<0.05), but no statistical differences were proved in Lysholm score or IKDC 2000 score between the two groups at any corresponding time points(P>0.05).[Conclusion] This result demonstrates that both tibial cortical suspensory fixation with screw post and interference screw tibia fixation achieve similar satisfactory clinical outcomes for ACL reconstruction.
引文
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[2]李永会,金利新,孙康.前交叉韧带股骨止点相关骨性标志的解剖学研究[J].2011,30(1):62-66.
[3]黄长明.影响关节镜下前交叉韧带重建手术疗效的相关因素[J].2010,18(20):1707-1710.
[4]Reiman PR,Jackson DW.Anatomy of the anterior cruciate ligament//Jackson DW,Drez D,editors.The anterior cruciate deficient knee.St.Louis:CV Mosby&Co.1987:17-26.
[5]张抒,陈晨,张军,等.前交叉韧带重建术保留残端韧带的方法及意义[J].中国骨与关节杂志,2013,2(9):522-525.
[6]邢基斯,冯宗权,侯蕾,等.胫骨骨道定位对前交叉韧带单束重建的影响[J].中国矫形外科杂志,2012,20(12):1092-1096.
[7]陈哲峰,王青,郭敦明,等.前交叉韧带断裂的关节镜下保留残端重建手术治疗[J].中国矫形外科杂志,2012,20(8):693-696.
[8]张春礼,徐虎,王迎春,等.前十字韧带移植重建后移植物撞击新类型[J].中华骨科杂志,2015,35(4):380-386.
[9]党保平,闫金洪,韩一生.膝交叉韧带中机械感受器的研究进展[J].2016,5(12):930-934.
[10]Van Eck CF,Lesniak BP,Schreiber VM,et al.Anatomic singleand double-bundle anterior cruciate ligament reconstruction flowchart[J].Arthroscopy,2010,26(2):258-268.
[2]李永会,金利新,孙康.前交叉韧带股骨止点相关骨性标志的解剖学研究[J].2011,30(1):62-66.
[3]黄长明.影响关节镜下前交叉韧带重建手术疗效的相关因素[J].2010,18(20):1707-1710.
[4]Reiman PR,Jackson DW.Anatomy of the anterior cruciate ligament//Jackson DW,Drez D,editors.The anterior cruciate deficient knee.St.Louis:CV Mosby&Co.1987:17-26.
[5]张抒,陈晨,张军,等.前交叉韧带重建术保留残端韧带的方法及意义[J].中国骨与关节杂志,2013,2(9):522-525.
[6]邢基斯,冯宗权,侯蕾,等.胫骨骨道定位对前交叉韧带单束重建的影响[J].中国矫形外科杂志,2012,20(12):1092-1096.
[7]陈哲峰,王青,郭敦明,等.前交叉韧带断裂的关节镜下保留残端重建手术治疗[J].中国矫形外科杂志,2012,20(8):693-696.
[8]张春礼,徐虎,王迎春,等.前十字韧带移植重建后移植物撞击新类型[J].中华骨科杂志,2015,35(4):380-386.
[9]党保平,闫金洪,韩一生.膝交叉韧带中机械感受器的研究进展[J].2016,5(12):930-934.
[10]Van Eck CF,Lesniak BP,Schreiber VM,et al.Anatomic singleand double-bundle anterior cruciate ligament reconstruction flowchart[J].Arthroscopy,2010,26(2):258-268.