摘要
目的比较联合线带尾端反折重建前外侧韧带(ALL)与单纯线带内支撑治疗高度轴移前交叉韧带(ACL)损伤的疗效。方法采用回顾性队列研究分析2021年3月至2023年3月中国人民解放军联勤保障部队第九一〇医院收治的60例高度轴移ACL损伤患者的临床资料,其中男48例,女12例;年龄18~40岁[(28.4±5.6)岁]。ACL损伤均为Ⅲ度。轴移试验:2级42例,3级18例。根据手术方式,30例行人工线带内支撑重建ACL联合线带尾端反折重建ALL(联合重建ACL组),30例行单纯线带内支撑重建ACL(单纯重建ACL组)。比较2组手术时长、术中出血量,术后3个月轴移改善率及末次随访时运动功能恢复率,术前、术后3个月及末次随访时Tegner评分、Lysholm评分,术后并发症发生率。结果患者均获随访6~24个月[(14.8±5.8)个月]。单纯重建ACL组手术时长为(44.6±8.2)min,术中出血量为(45.3±4.6)ml,均短于或少于联合重建ACL组的(58.0±7.4)min、(61.8±9.1)ml(P<0.01)。术后3个月,联合重建ACL组轴移改善率为93%(28/30),高于单纯重建ACL组的73%(22/30)(P<0.05)。末次随访时,联合重建ACL组运动功能恢复率为100%(30/30),高于单纯重建ACL组的80%(24/30)(P<0.05)。2组术前Tegner评分、Lysholm评分差异均无统计学意义(P>0.05)。术后3个月及末次随访时,联合重建ACL组Tegner评分分别为(3.8±0.5)分、(5.7±1.1)分,均高于单纯重建ACL组的(2.5±0.6)分、(3.9±0.9)分;Lysholm评分分别为(67.2±5.7)分、(89.4±6.4)分,均高于单纯重建ACL组的(56.4±5.0)分、(72.6±5.7)分(P<0.01)。2组术后各时间点Tegner评分、Lysholm评分均较术前逐渐提高(P<0.05)。末次随访时,联合重建ACL组胫骨骨道浅表感染1例,并发症发生率为3%(1/30);单纯重建ACL组胫骨骨道浅表感染1例,韧带损伤1例,并发症发生率为7%(2/30)(P>0.05)。结论对于高度轴移ACL损伤,人工线带内支撑重建ACL联合线带尾端反折重建ALL与单纯线带内支撑重建ACL相比,可显著提高膝关节旋转稳定性、促进运动功能恢复、改善膝关节功能。
Objective To compare the efficacy of internal brace-augmeted reconstruction combined with tape tail-folding anterolateral ligament reconstruction(ALL)and isolated internal brace-augmented reconstruction for high-grade pivot-shift anterior cruciate ligament(ACL)injuries.Methods A retrospective cohort study was conducted to analyze the clinical data of 60 patients with high-grade pivot-shift ACL injuries who were admitted to 910th Hospital of Joint Logistics Support Force of PLA between March 2021 and March 2023,including 48 males and 12 females,aged 18-40 years[(28.4±5.6)years].All ACL injuries were at grade Ⅲ.The pivot-shift test results were classified as grade 2 in 42 patients and grade 3 in 18.According to the surgical technique,30 patients underwent artificial internal brace-augmented ACL reconstruction combined with tape tail-folding ALL reconstruction(joint ACL reconstruction group),while the other 30 received isolated internal brace-augmented ACL reconstruction(simple ACL reconstruction group).The two groups were compared in terms of operative duration,intraoperative blood loss,improvement rate of pivot-shift at 3 months postoperatively,rate of sports function recovery at the last follow-up,Tegner and Lysholm scores preoperatively,at 3 months postoperatively,and at the last follow-up,and incidence of postoperative complications.Results All the patients were followed up for 6-24 months[(14.8±5.8)months].The operative duration and intraoperative blood loss were(44.6±8.2)minutes and(45.3±4.6)ml in the simple ACL reconstruction group,significantly shorter or less than(58.0±7.4)minutes and(61.8±9.1)ml in the joint ACL reconstruction group(P<0.01).At 3 months after surgery,the improvement of pivot-shift test was 93%(28/30)in the joint ACL reconstruction group,higher than 73%(22/30)in the simple ACL reconstruction group(P<0.05).At the last follow-up,the recovery rate of motor function was 100%(30/30)in the joint ACL reconstruction group,significantly higher than 80%(24/30)in the simple ACL reconstruction group(P<0.05).There were no statistically significant differences in Tegner or Lysholm scores between the two groups before surgery(P>0.05).At 3 months after surgery and at the last follow-up,the Tegner scores were(3.8±0.5)points and(5.7±1.1)points in the joint ACL reconstruction group,significantly higher than(2.5±0.6)points and(3.9±0.9)points in the simple ACL reconstruction group(P<0.01).At 3 months after surgery and at the last follow-up,the Lysholm scores were(67.2±5.7)points and(89.4±6.4)points in the joint ACL reconstruction group,significantly higher than(56.4±5.0)points and(72.6±5.7)points in the simple ACL reconstruction group(P<0.01).Both groups demonstrated gradual improvement in Tegner and Lysholm scores at all postoperative time points,compared to preoperative values(P<0.05).After operation,one patient in the joint ACL reconstruction group had superficial tibial infection,with a complication rate of 3%(1/30),whereas there was one patient with superficial tibial infection,and one with ligament injury in the simple ACL reconstruction group,with a total complication rate of 7%(2/30)(P<0.05).Conclusion For high-grade pivot-shift ACL injuries,internal brace-augmented reconstruction combined with tape tail-folding ALL reconstruction can significantly improve knee rotational stability,promote motor function recovery,and enhance knee joint outcomes,compared to isolated internal brace-augmented reconstruction.
作者
毛小成
黄亚男
洪庆南
尤瑞金
赵枫
Mao Xiaocheng;Huang Yanan;Hong Qingnan;You Ruijin;Zhao Feng(Department of Orthopedic Sports Medicine,910th Hospital of Joint Logistics Support Force of PLA,Quanzhou 362000,China)
出处
《中华创伤杂志》
北大核心
2025年第11期1086-1093,共8页
Chinese Journal of Trauma
关键词
前交叉韧带
损伤
关节不稳定性
前外侧韧带
Anterior cruciate ligament,injuries
Joint instability
Anterior cruciate ligament
