保留残端纤维双束重建后交叉韧带的病例对照研究

目的:评估"Y"形双束后交叉韧带重建中保留残端纤维的临床疗效。方法:自2007年1月至2010年11月,将符合纳入标准的单纯后交叉韧带陈旧性损伤患者50例,分为保留残端纤维组(保残组)和切除残端纤维组(不保残组)。保残组26例,男19例,女7例;年龄18～55岁,平均(32.250±11.085)岁;术前受伤时间2～66个月,平均(17.481±3.568)个月。不保残组24例,男17例,女7例;年龄20～54岁,平均(31.458±9.569)岁;术前受伤时间3～72个月,平均(19.354±3.950)个月。两组患者均有膝关节不稳,后抽屉试验阳性。保残组:术中保留髁间窝残端纤维、瘢痕组织及滑膜,仅切除导致髁间窝呈球状游离韧带组织。不保残组:切除残端纤维、瘢痕组织及其附着部滑膜组织。两组均采用自体半腱肌腱和股薄肌腱双束重建后交叉韧带,胫骨侧采用可吸收挤压钉与牵引线拴桩固定,股骨侧采用可吸收挤压钉与牵引线悬吊复合固定。术前及术后2年分别对两组患者进行主观评估(主观性IKDC、Lysholm评分及Cincinnati评分)和客观临床评估(客观IKDC评分、Kneelax3胫骨后移测试)。结果:主观评估结果比较:主观性IKDC评分,保残组92.167±4.177优于不保残组87.542±5.687(P=0.010);Lysholm评分,保残组90.917±4.413优于不保残组87.083±5.149(P=0.027);Cincinnati膝关节评分,保残组92.125±4.003优于不保残组87.791±6.665(P=0.027)。客观评估结果比较:客观IKDC评分,保残组与不保残组比较差异无统计学意义;Kneelax3检查,在132N力作用下用Kneelax3做胫骨后移测试,保残组与不保残组差异无统计学意义。结论:保留残端纤维与切除残端纤维双束重建后交叉韧带比较,保留残端纤维双束后交叉韧带重建术后膝关节主观功能恢复更好,而术后膝关节机械稳定性无明显差异。

Case-control studies on double bundle posterior cruciate ligament reconstruction with remnant fiber preservation

Objective: To study the clinical efficacy of double bundle posterior cruciate ligament (PCL) reconstruction with remnant preservation. Methods: From January 2007 to November 2011,50 patients with PCL rupture met the inclusion criteria were divided into two groups:remnant preservation group(RP group) and remnant resection group(RR group). There were 19 males and 7 females in the RP group,ranging in age from 18 to 55 years,with a mean of (32.250±11.085) years old. The duration from injury to operation ranged from 2 to 66 months,with an average of (17.481±3.568) months. Among the RR group,17 patients were male and 7 patients were female,ranging in age from 20 to 54 years old,with an average of (31.458±9.569) years. The duration from injury to operation ranged from 3 to 72 months,with a mean of (19.354±3.950) months. The patients in both groups suffered from instability of knee joint,got a positive result of posterior drawer test. In the RP group,the intercondylar notch remnant fiber,scar tissue and synovial were preserved in operation,only the free ligament in the intercondylar notch was resected. In the RR group,the remnant fiber,scar tissue and synovial tissue of adhesive parts were resected. In both groups,autologous semitendinosus and gracilis tendon double-bundle PCL reconstruction were carried out,the tibia was fixed with an absorbable interference screw with post-tie fixation,and the femur side was compositely fixed with absorbable interference screws and suspending fixation. Each patient received both subjective assessment (IKDC subjective evaluation,Lysholm scoring and Cincinnati rating) and objective clinical assessment (IKDC objective evaluation and Kneelax 3 tibia backward measurement) before operation and two years after operation. Results: IKDC subjective evaluation:92.167±4.177 in the RP group,which was higher than 87.542±5.687 in the RR group (P=0.010). Lysholm scores:90.917±4.413 in the RP group,which was higher than 87.083±5.149 in the RR group (P=0.027). Cincinnati knee scores:92.125±4.003 in the RP group,which was higher than 87.791±6.665 in the RR group(P= 0.027). IKDC objective evaluation:no significant statistical differences between RP group and RR group. Kneelax 3 assessment:tibia backward test with Kneelax 3 under 132 N showed no significant statistical difference between RP group and RR group,which were (3.958±0.693) mm and (4.029±0.846) mm respectively(P=0.795). Conclusion: The study shows a significant advantage of remnant fiber preservation than remnant fiber resection in double-bundle PCL construction in terms of subjective knee function recovery after operation. There is no significant difference in postoperative knee stability.