前交叉韧带重建联合前外侧韧带重建术治疗高度轴移的前交叉韧带损伤的疗效观察
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摘要
目的探讨前交叉韧带重建联合前外侧韧带重建术治疗高度轴移的前交叉韧带损伤的疗效。方法选取78例前交叉韧带损伤患者为研究对象,采用随机数字表法分为对照组和联合组各39例,对照组行前交叉韧带重建术治疗,联合组行前交叉韧带重建联合前外侧韧带重建术治疗,比较2组稳定性分级、膝关节活动度、肌力恢复情况、Lysholm评分变化及手术安全性。结果术前,2组间稳定性分级、屈曲受限角度、伸膝受限角度、萎缩指数、Lysholm评分无显著差异(P> 0. 05);术后,联合组稳定性评估结果显著优于对照组(P <0. 05);术后,2组屈曲受限角度、伸膝受限角度、萎缩指数较术前显著降低,且联合组显著低于对照组(P <0. 05);术后1、3、5个月,联合组Lysholm评分显著高于对照组(P <0. 05),术后2组并发症总发生率差异无统计学意义(P> 0. 05)。结论前交叉韧带重建联合前外侧韧带重建术治疗高度轴移的前交叉韧带损伤患者效果显著,在改善患者关节稳定性、膝关节活动度、肌力恢复情况等方面有积极作用,且有一定安全性。
Objective To observe the effect of anterior cruciate ligament reconstruction combined with anterior lateral ligament reconstruction on treating anterior cruciate ligament injury with high-grade pivot-shift. Methods A total of 78 patientswith anterior cruciate ligament injury admitted to the hospital were enrolled in the study,and were divided into control group and combined group by random number table method,with 39 cases in each group. The control group was given anterior cruciate ligament reconstruction,while the observation group was given anterior cruciate ligament reconstruction combined with anterior lateral ligament reconstruction. The stability grading,knee range of motion,recovery of muscle strength,change of Lysholm scoring and surgical safety were compared between the two groups. Results There were no significant differences in stability grading,limited angle of knee flexion,limited angle of knee extension,atrophy index and Lysholm score between the two groups before the surgery( P > 0. 05). The stability of the combined group was significantly higher than that of the control group after the surgery( P < 0. 05). The limited angle of knee flexion,limited angle of knee extension and atrophy index were significantly decreased in both groups after the surgery,and the above indexes in the combined group was significantly lower than those in the control group( P < 0. 05). The Lysholm scores of the combined group at 1,3 and 5 months after the surgery were significantly higher than those of the control group( P < 0. 05). There was no significant difference inthe total incidence of complications after the surgery between the two groups( P > 0. 05).Conclusion The curative effect of anterior cruciate ligament reconstruction combined with anterior lateral ligament reconstruction is significant for the treatment of patients with anterior cruciate ligament injury with high-grade pivot-shift,which plays a positive role in improving joint stability,knee range of motion and recovery of muscle strength,and has higher safety.
Objective To observe the effect of anterior cruciate ligament reconstruction combined with anterior lateral ligament reconstruction on treating anterior cruciate ligament injury with high-grade pivot-shift. Methods A total of 78 patientswith anterior cruciate ligament injury admitted to the hospital were enrolled in the study,and were divided into control group and combined group by random number table method,with 39 cases in each group. The control group was given anterior cruciate ligament reconstruction,while the observation group was given anterior cruciate ligament reconstruction combined with anterior lateral ligament reconstruction. The stability grading,knee range of motion,recovery of muscle strength,change of Lysholm scoring and surgical safety were compared between the two groups. Results There were no significant differences in stability grading,limited angle of knee flexion,limited angle of knee extension,atrophy index and Lysholm score between the two groups before the surgery( P > 0. 05). The stability of the combined group was significantly higher than that of the control group after the surgery( P < 0. 05). The limited angle of knee flexion,limited angle of knee extension and atrophy index were significantly decreased in both groups after the surgery,and the above indexes in the combined group was significantly lower than those in the control group( P < 0. 05). The Lysholm scores of the combined group at 1,3 and 5 months after the surgery were significantly higher than those of the control group( P < 0. 05). There was no significant difference inthe total incidence of complications after the surgery between the two groups( P > 0. 05).Conclusion The curative effect of anterior cruciate ligament reconstruction combined with anterior lateral ligament reconstruction is significant for the treatment of patients with anterior cruciate ligament injury with high-grade pivot-shift,which plays a positive role in improving joint stability,knee range of motion and recovery of muscle strength,and has higher safety.
引文
[1]宋伟毅,林超文,吴宇峰,等.关节镜下规避骺板法治疗儿童前交叉韧带胫骨止点撕脱性骨折[J].中华创伤骨科杂志,2016,18(2):144-148.
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[4]张太良,张磊,廉志明,等.关节镜下前交叉韧带重建保留残端与否干预膝关节本体感觉功能恢复的Meta分析[J].中国组织工程研究,2017,21(3):471-477.
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[9] Smith C K,Howell S M,Hull M L. Anterior laxity,slippage,and recovery of function in the first year after tibialis allograft anterior cruciate ligament reconstruction[J]. Am J Sports Med,2011,39(1):78-88.
[10]章亚东,侯树勋,张轶超,等.关节镜下前交叉韧带重建后内侧和外侧半月板同期移植术[J].中华外科杂志,2011,49(7):581-585.
[11]吴关,洪雷,沈杰威,等.前外侧韧带重建术治疗合并高度轴移的前交叉韧带损伤:手术技术及早期随访结果[J].中国运动医学杂志,2018,37(1):14-18.
[12]王慧.膝关节双束前交叉韧带重建术后的影像学评估[D].苏州:苏州大学,2014.
[13]郭新毅,毕树雄.前交叉韧带重建术治疗急性与陈旧性前交叉韧带损伤的疗效研究[J].中国药物与临床,2017,17(6):876-879.
[14]李懋,徐斌,涂俊.不同手术时机行关节镜下前交叉韧带重建术临床对比分析[J].山东医药,2016,56(48):50-52.
[2]郭韵,杜良杰,李建军,等.前交叉韧带重建术后膝关节的神经肌肉功能重塑[J].中国康复理论与实践,2016,22(1):65-68.
[3]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.
[4]张太良,张磊,廉志明,等.关节镜下前交叉韧带重建保留残端与否干预膝关节本体感觉功能恢复的Meta分析[J].中国组织工程研究,2017,21(3):471-477.
[5]吴博,张雷,庞文君,等.全身振动训练对前交叉韧带损伤重建术后患者下肢运动控制的影响[J].中国康复医学杂志,2016,31(4):421-425.
[6] Liossatou E,Fardis M N. Near-fault effects on residual displacements of RC structures[J]. Earthquake Engng Struct Dyn,2016,45(9):1391-1409.
[7]刘心,张辉,冯华,等.前外侧肌腱固定术在治疗合并高度轴移不稳定的前交叉韧带损伤患者中的应用[J].中国运动医学杂志,2017,36(2):101-105.
[8]张春礼,丁明,杜天舒.膝关节前交叉韧带重建术中膝关节前外侧韧带的价值[J].中国微创外科杂志,2016,16(7):577-580.
[9] Smith C K,Howell S M,Hull M L. Anterior laxity,slippage,and recovery of function in the first year after tibialis allograft anterior cruciate ligament reconstruction[J]. Am J Sports Med,2011,39(1):78-88.
[10]章亚东,侯树勋,张轶超,等.关节镜下前交叉韧带重建后内侧和外侧半月板同期移植术[J].中华外科杂志,2011,49(7):581-585.
[11]吴关,洪雷,沈杰威,等.前外侧韧带重建术治疗合并高度轴移的前交叉韧带损伤:手术技术及早期随访结果[J].中国运动医学杂志,2018,37(1):14-18.
[12]王慧.膝关节双束前交叉韧带重建术后的影像学评估[D].苏州:苏州大学,2014.
[13]郭新毅,毕树雄.前交叉韧带重建术治疗急性与陈旧性前交叉韧带损伤的疗效研究[J].中国药物与临床,2017,17(6):876-879.
[14]李懋,徐斌,涂俊.不同手术时机行关节镜下前交叉韧带重建术临床对比分析[J].山东医药,2016,56(48):50-52.