摘要
目的:观察术前关节松弛程度对前交叉韧带损伤行关节镜自体腘绳肌腱重建术疗效的影响,及与术后关节稳定性的相关性。方法:选择80例前交叉韧带损伤患者作为研究对象,根据入院时关节松弛程度评估情况,将beighton关节过度运动评分量表≥4分的45例患者作为阳性组(全身关节韧带松弛),评分<4分的35例患者作为阴性组(全身关节韧带正常),2组患者均接受关节镜自体腘绳肌腱重建术治疗,比较2组患者膝关节功能、膝关节本体感觉功能恢复情况,对所有患者随访半年,比较2组关节稳定性改善情况。通过spearman相关性系数检验术前关节松弛程度与术后关节稳定性的相关性。结果:治疗前,2组患者膝关节功能、膝关节本体感觉功能、关节稳定性差异均无统计学意义(P>0.05);治疗后,阳性组的lysholm膝关节功能评分为(85.45±5.31)分,tegner膝关节运动评分为(6.12±2.33)分,国际膝关节评分委员会量表(IKDC)评分为(85.75±5.26)分,均低于阴性组[(88.49±5.36)分、(7.41±2.26)分、(88.39±5.42)分],差异有统计学意义(P<0.05);治疗后,阳性组的膝关节本体被动重新定位角度绝对误差值为1.26±0.37,被动运动察觉阈值时间为(1.62±0.45)s,均高于阴性组[(0.77±0.26)s、(0.75±0.31)s],差异有统计学意义(P<0.05);随访期间,阳性组内侧副韧带(MCL)为(16.75±5.31)°,外侧副韧带(LCL)为(7.72±2.41)°,均高于阴性组[(13.39±5.37)°、(6.14±2.88)°],阳性组kneelax测量值为(4.23±1.45)mm,低于阴性组(5.12±1.41)mm,差异有统计学意义(P<0.05);经spearman相关性系数检验,术前beighton评分与术后内侧、外侧副韧带活动度评分呈正相关,与kneelax测量值呈负相关。结论:关节镜自体腘绳肌腱重建术可有效改善前韧带交叉损伤患者的膝关节活动功能、本体感觉功能及关节稳定性,但其手术疗效可受术前关节松弛度影响,在术前综合评估关节功能并针对性干预对增强手术疗效有积极作用。
Objective:The effect of joint laxity on the efficacy of hamstring tendon autograft for anterior cruciate ligament re-construction and its correlation with postoperative joint stability.Methods:This study selected 80 patients with anterior cruciate liga-ment injury(ACL injury)admitted.Based on the assessment of joint laxity at the time of admission,45 patients with a score of≥4 on the Beighton Scale were classified as a positive group(generalized ligamentous laxity of the joints),while 35 patients with a score of<4 were classified as a negative group(generalized normal ligamentous laxity of the joints),Both groups of patients re-ceived hamstring tendon autograft for anterior cruciate ligament reconstruction.The recovery of knee joint function and propriocep-tive function of the two groups of patients was compared.All patients were followed up for six months to compare the improvement of joint stability between the two groups.The correlation between preoperative joint laxity and postoperative joint stability was tested u-sing the Spearman correlation coefficient.Results:Before treatment,there was no statistically significant difference in knee joint function,proprioceptive function,and joint stability between the two groups of patients(P>0.05).After treatment,the lysholm score of the positive group was(85.45±5.31)points,the tegner score was(6.12±2.33)points,and the IKDC score was(85.75±5.26)points,all lower than those of the negative group[(88.49±5.36)points,(7.41±2.26)points,(88.39±5.42)points](P<0.05).After treatment,the absolute error value of the passive repositioning angle of the knee joint proper in the posi-tive group was(1.26±0.37),and the passive motion detection threshold time was(1.62±0.45)s,which were higher than those in the negative group[(0.77±0.26)s,(0.75±0.31)s](P<0.05).During the follow-up period,the medial collateral ligament(MCL)of the positive group was(16.75±5.31)°,and the lateral collateral ligament(LCL)was(7.72±2.41)°,both higher than those of the negative group[(13.39±5.37)°,(6.14±2.88)°].The Kneelax measurement value of the positive group was(4.23±1.45)mm,lower than the negative group(5.12±1.41)mm,and the difference was statistically significant(P<0.05).After the Spearman correlation coefficient test,the preoperative Beighton score was positively correlated with the postoperative medi-al and lateral collateral ligament activity scores,and negatively correlated with the Kneelax measurement values.Conclusion:Ham-string tendon autograft for anterior cruciate ligament reconstruction can effectively improve knee joint mobility,proprioceptive func-tion,and joint stability in patients with ACL injury,but its surgical efficacy can be affected by preoperative joint laxity.Comprehen-sive evaluation of joint function before surgery and targeted intervention have a positive effect on enhancing surgical efficacy.
作者
范存帅
FAN Cunshuai(Department of Orthopedics,Pingdingshan First People’s Hospital)
出处
《长治医学院学报》
2023年第5期349-353,共5页
Journal of Changzhi Medical College
基金
河南省医学科技攻关项目(LHGJ202101263)。
