关节镜下屈膝外翻位经前内侧辅助入路重建前交叉韧带手术体会
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摘要
目的探讨关节镜下屈膝外翻位经前内侧辅助入路重建前交叉韧带(ACL)疗效。方法2014年1月—2017年1月泸州市中医医院治疗38例因ACL损伤而接受重建手术患者,其中男性22例,女性16例;年龄17～63岁,平均36岁;右膝21例,左膝17例。致伤原因:运动伤22例,道路交通伤12例,其他4例。采用关节镜下屈膝外翻位经前内侧辅助入路建立股骨隧道方式进行ACL重建。术后12个月,对患者膝关节采用Lysholm评分表及IKDC 2000膝关节主观评价表进行疗效评价。结果 38例患者均获得随访,时间12～18个月,平均14个月。术中无后壁破裂情况发生,术后无感染、神经血管损伤、深静脉血栓等严重并发症发生。Lysholm评分由术前的(52. 71±7. 50)分提高至(90. 39±3. 26)分; IKDC评分由术前的(48. 87±9. 05)分提高至(89. 16±4. 29)分(P <0. 05)。术后1年随访显示4例出现Ⅰ度松弛(11. 76%)。结论屈膝外翻位经前内侧辅助入路更有利于ACL重建,具有视野开阔、操作简单、安全有效等优势。
Objective To investigate the effect of anterior cruciate ligament (ACL) reconstruction throughanterior medial approach via knee flexor valgus under arthroscope. Methods Totally 38 patients with anterior cru-ciate ligament injury were enrolled in our hospital from Jan. 2014 to Jan. 2017. The reconstruction of anterior cruci-ate ligament was carried out through anterior medial approach via knee flexor valgus under arthroscope. There were22 males and 16 females aged from 17-63 ( average,36) years. Totally 21 cases were on the right and 17 were onthe left. Totally 22 were injured from sports,12 were from traffic accidents and 4 were from other reasons. The Ly-sholm score and IKDC2000 subjective evaluation system were used to evaluate the efficacy of the knee joint 12 months after surgery. Results All the 38 patients were followed up from 12 to 18 months,with an average of 14 months,with no posterior wall rupture,infection,neurovascular injury,deep venous thrombosis or other serious compli-cations. The Lysholm score was increased to (90. 39 ± 3. 26) points from before operation (52. 71 ± 7. 50),and thescore of IKDC score was increased from (48. 87 ± 9. 05) to (89. 16 ± 4. 29) points (P < 0. 05). After 1 year of follow-up,4 patients had grade I relaxation (11. 76%). Conclusion The anterior knee medial approach is more conduciveto ACL reconstruction. It has advantages of wide field of vision,simple operation,safety and effectiveness.
Objective To investigate the effect of anterior cruciate ligament (ACL) reconstruction throughanterior medial approach via knee flexor valgus under arthroscope. Methods Totally 38 patients with anterior cru-ciate ligament injury were enrolled in our hospital from Jan. 2014 to Jan. 2017. The reconstruction of anterior cruci-ate ligament was carried out through anterior medial approach via knee flexor valgus under arthroscope. There were22 males and 16 females aged from 17-63 ( average,36) years. Totally 21 cases were on the right and 17 were onthe left. Totally 22 were injured from sports,12 were from traffic accidents and 4 were from other reasons. The Ly-sholm score and IKDC2000 subjective evaluation system were used to evaluate the efficacy of the knee joint 12 months after surgery. Results All the 38 patients were followed up from 12 to 18 months,with an average of 14 months,with no posterior wall rupture,infection,neurovascular injury,deep venous thrombosis or other serious compli-cations. The Lysholm score was increased to (90. 39 ± 3. 26) points from before operation (52. 71 ± 7. 50),and thescore of IKDC score was increased from (48. 87 ± 9. 05) to (89. 16 ± 4. 29) points (P < 0. 05). After 1 year of follow-up,4 patients had grade I relaxation (11. 76%). Conclusion The anterior knee medial approach is more conduciveto ACL reconstruction. It has advantages of wide field of vision,simple operation,safety and effectiveness.
引文
[1]刘欣伟,刘松波,刘铭,等.急性膝前交叉韧带损伤的关节镜治疗临床研究[J].创伤外科杂志,2017,19(7):527-529.
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[7]郭艳宇,王振虎,吴羽,等.股骨止点两种不同定位方法对前交叉韧带重建术后近期疗效的影响[J].中国现代医学杂志,2016,26(1):137-140.
[8]Markolf KL,Jackson SR,Mcall ister DR.A comparison of 11 o'clock versus oblique femoral tunnels in the anterior cruciate ligament-reconstructed knee:knee kinematics during a simulated pivot test[J].Am J Sports Med,2010,38(5):912-917.
[9]钱约男,董伊隆,姜刚毅,等.前交叉韧带解剖重建股骨隧道的X线测量与分析[J].温州医学院学报,2014,44(8):596-599.
[10]孔颖,王国栋,张元民,等.前交叉韧带重建失败后的首次翻修[J].中国组织工程研究,2014,18(46):7458-7462.
[11]徐虎,张春礼,裴国献,等.改良关节镜下前交叉韧带重建术的安全性研究[J].中国微创外科杂志,2011,11(12):1096-1098.
[12]Fu FH,Shen W,Starman JS,et al.Primary anatomic double-bundle anterior cruciate ligament reconstruction:a preliminary 2-year prospective study[J].Am J Sports Med,2008,36(7):1263-1274.
[2]张辉,冯华,洪雷,等.导航辅助前十字韧带单束与双束重建的比较研究[J].中华骨科杂志,2012,32(6):557-564.
[3]韩序勇,张庆文.前交叉韧带个体化解剖重建研究进展[J].中国中医骨伤科杂志,2016,9(24):74-77.
[4]王辉,韩雪松,王金水,等.由外向内与经前内侧入路法重建前交叉韧带股骨隧道的比较[J].中华关节外科杂志(电子版),2015,9(4):56-59.
[5]马亮,许永涛,佘远举.关节镜下经前内侧入路个体化解剖重建前交叉韧带的疗效观察[J].中国内镜杂志,2016,22(3):51-55.
[6]赵双利,王世轩,李洪涛.前交叉韧带重建术中股骨隧道定位方法的发展趋势[J].中医正骨,2015,27(1):63-65.
[7]郭艳宇,王振虎,吴羽,等.股骨止点两种不同定位方法对前交叉韧带重建术后近期疗效的影响[J].中国现代医学杂志,2016,26(1):137-140.
[8]Markolf KL,Jackson SR,Mcall ister DR.A comparison of 11 o'clock versus oblique femoral tunnels in the anterior cruciate ligament-reconstructed knee:knee kinematics during a simulated pivot test[J].Am J Sports Med,2010,38(5):912-917.
[9]钱约男,董伊隆,姜刚毅,等.前交叉韧带解剖重建股骨隧道的X线测量与分析[J].温州医学院学报,2014,44(8):596-599.
[10]孔颖,王国栋,张元民,等.前交叉韧带重建失败后的首次翻修[J].中国组织工程研究,2014,18(46):7458-7462.
[11]徐虎,张春礼,裴国献,等.改良关节镜下前交叉韧带重建术的安全性研究[J].中国微创外科杂志,2011,11(12):1096-1098.
[12]Fu FH,Shen W,Starman JS,et al.Primary anatomic double-bundle anterior cruciate ligament reconstruction:a preliminary 2-year prospective study[J].Am J Sports Med,2008,36(7):1263-1274.