影响前交叉韧带重建术疗效因素的临床研究

目的比较前交叉韧带重建的不同手术时机以及是否合并关节内损伤等因素对临床疗效的影响。方法选择前交叉韧带重建手术病例79例进行临床随访。根据手术距受伤时间不同分组,分析组间合并损伤情况。根据是否合并半月板或内侧副韧带损伤分组,分析各组间手术前后膝关节功能的差别。结果术后Lysholm评分与Tegner分级均明显提高,髌前疼痛发生率15.15%,早期手术组合并内侧副韧带损伤发生率较高（P〈0.05）,早期与晚期手术的半月板损伤发生率无统计学差异。不同手术时期术后Lysholm评分和Tegner分级无显著性差异（P〉0.05）。合并半月板损伤或内侧副韧带损伤对临床结果的统计分析,两者均无显著性差异。结论不同手术时机短期内未造成临床结果差异。建议早期重建前交叉韧带,同时对合并的侧副韧带和半月板损伤进行处理,以保护关节软骨,重建膝关节稳定性。

The Clinical Study on Influencing Factors of Outcome for Anterior Cruciate Ligament Reconstruction

Objective To compare the clinical outcome of different time of operation of reconstruction of the anterior cruciate ligament（ACL） and combined intraarticular injuries.Methods Seventy-nine patients underwent arthroscopic ACL reconstruction using central-third,bone-patellar tendon-bone autograft and interference screw fixation were selected.Sixty-six patients were followed up average eighteen months.The patients were divided into acute group,subacute group and chronic group according time of operation.The proportion of combined intraarticular injuries of different gruops were evaluated.Effects on function of the joint of combined intraarticular injuries were analyzed.Results The Lysholm score and the Tegner activity score rose average 41.05±13.83 and 2.56±1.37 at follow-up respectively.Ten patients （15.15%） had obvious patellofemoral pain.There was no significant difference in the Lysholm score and the Tegner activity score between the acute,subacute and chronic group at follow-up.Statistical evaluation showed no significant difference for clinical result between groups with combined meniscal or medial collateral ligament injury and group without injury.Conclusion There was no difference in the clinical outcome between difference time of operation.The early surgery was suggested in order to protect articular cartilage and reconstruction stability of the knee.