关节镜下同时保留股骨及胫骨残端重建前交叉韧带的临床疗效评估

目的 探讨关节镜下采取同时保留股骨及胫骨残端方式重建前交叉韧带的技术应用并观察其效果。方法 选取安徽医科大学第一附属医院2014年1月至2016年1月收住的前交叉韧带（ACL）损伤患者52例，术前依据随机数字表法分为同时保留胫骨及股骨韧带残端重建ACL组（保残组）与不保留任何韧带残端重建ACL组（对照组）并按照单束重建ACL方法完成手术，每组26例。采用Lysholm膝关节功能评分评估客观功能及行为能力，采用国际膝关节文献委员会（IKDC）主观评分评估主观运动能力及生活质量，比较两组患者术前、术后18个月上述评分标准评估的患者膝关节功能。所有患者于术后6个月复查磁共振，观察移植肌腱与骨隧道的愈合情况及有无其他关节异常信号。结果 保残组患者膝关节术前Lysholm评分和IKDC评分均低于术后（57.21±5.05）分vs（89.43±4.12）分；（52.18±7.61）分vs（91.43±4.52）分]，差异有统计学意义（P<0.05）。对照组患者术前Lysholm评分和IKDC评分均低于术后（54.72±4.06）分vs（86.21±3.89）分；（56.24±6.59）分vs（83.56±5.02）分]，差异有统计学意义（P<0.05）。术后IKDC主观评分保残组优于对照组（91.43±4.52）分vs（83.56±5.02）分]，且差异有统计学意义（P<0.05）。所有患者术后未发生严重并发症。结论 关节镜下同时保留胫骨及股骨侧残端重建前交叉韧带术术后效果良好，无不良并发症，有利于前交叉韧带重建术后膝关节功能的恢复。

Effectiveness of arthroscopic anterior cruciate ligament reconstruction with retention of tibia and femoral remnant preservation

Objective To investigate the skill of and outcome of arthroscopic reconstruction of anterior cruciate ligament (ACL) with retention of both tibia and femoral remnant. Methods A total of 52 patients with ACL injury, ever treated in our hospital between Jan 2014 and Jan 2016, were enrolled and divided into two groups by means of random number table. Patients in preservation group underwent ACL reconstruction with preservation of both tibia and femoral remnants, and those in control group had their remnants resected. The Lysholm score(to evaluate the knee active status) and International Knee Documentation Committee (IKDC) subjective score(to evaluate the subjective knee status) before operation and at 18 months after operation in both groups were assessed, and the differences between two groups were compared and analyzed. All patients underwent MRI examination six months post operation to evaluate the tendon-bone healing and other signs in knees. Results In preservation group, the mean Lysholm score increased from 57.21±5.05 to 89.43±4.12, and the mean IKDC subjective knee score increased from 52.18±7.61 to 91.43±4.52. Compared with control group, the mean Lysholm score was elevated from54.72±4.06 to 86.21±3.89, and the mean IKDC subjective knee score was up-regulated from56.24±6.59 to 83.56±5.02. The difference in pre-surgery and post-surgery scores had statistical significance in both groups(P<0.05). Compared with control group, the preservation group had significantly higher postoperative IKDC subjective score(P<0.05). All patients had no severe complications at early stage.Conclusion Arthroscopic single-bundle ACL reconstruction with three different remnant models of preservation has potential facility to revasculization and reinnervation of the reconstructed ligament in more than 18 months'' follow up.