前交叉韧带联合前外侧韧带重建治疗前交叉韧带损伤的短期临床疗效研究

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摘要目的探讨前交叉韧带(anterior cruciate ligament，ACL)单束重建与联合不同方式前外侧韧带(anterolateral ligament，ALL)重建治疗ACL损伤的短期临床效果。方法回顾性分析我院运动医学科2020年1月至2021年1月诊治的79例ACL损伤患者，均接受关节镜手术治疗，其中男65例，女14例；年龄17~58岁，平均(29.53±10.19)岁。79例中25例行ACL自体腘绳肌腱单束重建(A组)，24例行ACL联合ALL自体腘绳肌腱重建(B组)，18例行ACL联合ALL髂胫束重建(C组)，12例行ACL联合ALL同种异体腘绳肌腱重建(D组)。术前及术后对所有患者行Lysholm膝关节功能评分，膝关节损伤与骨关节炎评分(knee injury and osteoarthritis outcome score，KOOS)，运动时膝关节稳定性/急转身转向功能(knee stability in sports/cutting-pivoting ability，KSS/CPA)评级，Lachman试验、轴移试验和中立位前抽屉试验。术后采用6阶段康复方案。观察比较四种术式治疗ACL损伤的短期临床效果。结果本研究79例患者随访时间7~20个月，平均(14.27±3.19)个月。四组患者均Ⅰ期愈合，无感染等并发症。四组患者术后及末次随访时的Lachman试验和中立位前抽屉试验均为阴性。术前及麻醉前查体四组患者均为高级轴移(≥Ⅱ级)，末次随访时单纯前交叉韧带重建术(anterior cruciate ligament reconstruction，ACLR)组4例Ⅰ级轴移，三个联合重建组均消除轴移，四组与术前比较差异均有统计学意义(P＜0.05)，单纯ACLR组与三组联合重建组间比较，差异均有统计学意义(P＜0.05)，联合重建组间比较差异无统计学意义(P＞0.05)。四组Lysholm评分及KSS评级较术前增高，与术前比较差异均有统计学意义(P＜0.05)，术后四组间差异无统计学意义(P＞0.05)。CPA评级中三个联合重建组均较术前增高，差异有统计学意义(P＜0.05)，组间比较差异无统计学意义(P＞0.05)，但单纯ACLR组与术前比较差异无统计学意义(P＞0.05)。KOOS各子项评分与术前比较均增高，差异均有统计学意义(P＜0.05)。三个联合重建组在日常生活、运动娱乐、生活质量三个子项评分中优于单纯ACLR组(P＜0.05)，联合重建组之间差异无统计学意义(P＞0.05)。结论相较于单纯ACLR，ACL损伤的患者联合ALL重建短期内能更好地恢复膝关节功能，更适用于对膝关节旋转功能要求较高的人群。ALL加强技术与重建技术在短期术后效果上没有明显差异。

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	何嘉炜
	张克远 *

关键词 ：前交叉韧带, 关节镜, 前外侧韧带, 膝关节功能, Lysholm评分

Abstract：Objective To explore the short-term clinical effects of anterior cruciate ligament (ACL) single-bundle reconstruction，and ACL combined with different methods of anterolateral ligament (ALL) reconstruction in the treatment of ACL injury.Methods A retrospective analysis of 79 caseswith ACL injuries diagnosed and treated in the Department of Sports Medicine of the first clinical medical college of Xinjiang Medical University from January 2020 to January 2021 was carried out.All the patients underwent arthroscopic surgery，including 65 males and 14 females，aged 17~58 years old with an average of (29.53±10.19) years old.Among 79 cases，25 cases underwent ACL autologous hamstring tendon single bundle reconstruction (group A)，24 cases underwent ACL combined with ALL autologous hamstring tendon reconstruction (group B)，18 cases underwent ACL combined with ALL iliotibial band reconstruction (group C)，12 cases of ACL combined with ALL allogeneic hamstring tendon reconstruction (group D).Lysholm knee function score，knee injury and osteoarthritis outcome score (KOOS)，knee stability in sports/cutting-pivoting ability(KSS/CPA)rating，Lachman test，axis shift test and neutral front drawer test were performed before and after surgery.A 6-stage rehabilitation program was adopted after the operation.The short-term clinical effects of four surgical treatments for ACL injuries were observed and compared.Results The follow-up period of 79 patients in this study was 7~20 months，with an average of (14.27±3.19) months.All patients in the four groups healed in thefirst stagewithout infection and other complications.The Lachman test and the neutral anterior drawer test were negative after surgery and during the last follow-up.The physical examination before operation and anesthesia were all high-grade axial displacement (≥grade Ⅱ).At the last follow-up，there were 4 patients in the group A with grade Ⅰ axial displacement，and the three combined reconstruction groups eliminated axial displacement.Comparing with pre-operation，the differences were statistically significant (P＜0.05).The comparison between group A and three combined reconstruction groups significant differences(P＜0.05)，and there was no statistically significant difference between the combined reconstruction groups (P＞0.05).The Lysholm score and KSS score of the four groups of patients were higher than those before the operation，and the differences were statistically significant (P＜0.05)，and there was no significant difference between the four groups (P＞0.05).The three combined reconstruction groups in the CPA rating were all higher than those before the operation，the difference was statistically significant (P＜0.05)，the difference between the groups was not statistically significant (P＞0.05).However，there was no statistical difference before and after surgery in the group A(P＞0.05).The scores of all sub-items of KOOS were higher than those before operation，and the differences were statistically significant (P＜0.05).The three combined reconstruction groups were better than the group A in the scores of daily life，sports and entertainment，and quality of life (P＜0.05)，and there was no statistically significant difference between the combined reconstruction groups(P＞0.05).Conclusion Compared with simple ACL reconstruction，patients with ACL injury who were operated by ACL combined with ALL selected reconstruction can better restore knee joint function in a short period of time，and it is more suitable for people with higher requirements for knee joint rotation function.There is no significant difference between ACL combined with selected reconstruction technique in the short-term postoperative effect.

Key words： anterior cruciate ligament arthroscopy anterolateral ligament knee function Lysholm score

通讯作者: 张克远

作者简介: 何嘉炜(1995－ )，男，研究生在读，新疆医科大学第一临床医学院运动医学科，830054。

引用本文:

何嘉炜，张克远 *. 前交叉韧带联合前外侧韧带重建治疗前交叉韧带损伤的短期临床疗效研究[J]. 实用骨科杂志, 2021, 27(12): 1080-1086.
He Jiawei，Zhang Keyuan *. Treatment of Anterior Cruciate Ligament Injury Using Anterior Cruciate Ligament Combined with Anterolateral Ligament Reconstruction：A Short-term Clinical Efficacystudy. sygkzz, 2021, 27(12): 1080-1086.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2021/V27/I12/1080

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