前交叉韧带保残重建术中保残策略病例对照研究

目的：比较前交叉韧带保残重建与非保残重建、保留残端重建与保留残根重建的临床疗效。方法：自2014年3月至2017年12月采用自体腘绳肌腱单束重建前交叉韧带断裂患者204例，根据前交叉韧带重建方式不同分为保留残端重建组（A组）、保留残根重建组（B组）和清理残端残根的非保残重建组（C组）。A组76例，男37例，女39例，年龄16~43（28.80±5.41）岁，受伤至手术时间2~11（3.68±1.04）周，采用保留残端前交叉韧带重建术。B组64例，男39例，女25例，年龄18~41（28.42±5.60）岁，受伤至手术时间2~10（3.36±1.68）周，采用保留残根前交叉韧带重建术。C组64例，男37例，女27例，年龄18~43（29.10±6.11）岁，受伤至手术时间3~11（3.54±1.46）周，采用清理残端残根的非保残重建术。术前、术后24个月采用膝关节活动度（range of motion，ROM）观察膝关节屈伸活动范围。术前及术后6、12、24个月采用Lysholm评分和国际膝关节文献委员会（International Knee Documentation Committee，IKDC）评分评估膝关节功能。结果：所有患者术后伤口Ⅰ期愈合，无血管、神经损伤及关节感染等并发症发生。所有患者获随访，A组随访24.00~45.96（35.52±14.40）个月，B组27.96~48.00（37.56±10.68）个月，C组24.00~66.00（37.08±13.44）个月，3组随访时间比较差异无统计学意义（P>0.05）。术后6个月，A组Lysholm评分（82.52±5.24）分，IKDC评分（79.92±3.44）分，高于B组的（80.74±3.14）分和（78.21±4.63）分，且高于C组的（79.22±3.63）分和（76.63±3.80）分（P<0.05）；术后12个月，A组Lysholm评分（89.84±5.13）分，IKDC评分（87.90±3.93）分，高于B组的（85.74±6.04）分和（83.62±5.64），且高于C组的（82.83±3.43）分和（79.21±4.04）分（P<0.05）。结论：前交叉韧带保残重建术与非保残重建术相比保留了前交叉韧带残端组织，有利于促进肌腱移植物愈合和重塑，加速关节功能恢复。保残重建术中妥善固定残端组织，恢复其张力，是影响术后疗效的关键因素。

Case-control study on remnant-preserving strategy for preservation and reconstruction of anterior cruciate ligament

Objective: To investigate and compare the clinical efficacies of remnant-preserving and remnant-non-preserving,remnant-non-preserving remnant segment preserving and remnant root preserving with anterior cruciate ligament reconstruction.Methods: From March 2014 to December 2017,204 patients with anterior cruciate ligament (ACL) injuries were treated by single-bundle ACL reconstruction with hamstring tendon autograft. According to the different methods of remnant preservation,the procedures were divided into remnant segment preserving group (A),remnant root preserving group (B),and remnant-non-preserving group (C). There were 37 males and 39 females in group A aged from 16 to 43 years old with an average of (28.80±5.41) years old. The time from injury to operation ranged from 2 to 11 weeks with an average of (3.68±1.04) weeks. In group B,there were 39 males and 25 females aged from 18 to 41 years old with an average of (28.42±5.60) years old. The time from injury to operation ranged from 2 to 10 weeks with an average of (3.36±1.68) weeks. In group C,there were 37 males and 27 females aged from 18 to 43 years old with an average of (29.10±6.11) years old. The time from injury to operation ranged from 3 to 11 weeks with an average of (3.54±1.46) weeks. The range of motion (ROM) of the knee was used to assess the range of extension and flextion of the knee at pre-operation and 24 months after operation. Lysholm score and the international knee documentation committee (IKDC) score were used to assess the knee function. The differences among three procedures were judged by comparing among the three groups at 6,12 and 24 months postoperatively.Results: All incisions got a one stage healing,and no complications,such as vascular injury,nerve damage and articular infect or the like,occurred. All the patients were followed up,and the follow-up duration of group A ranged from 24.00 to 45.96 months with a mean of (35.52±14.40) months;the follow-up duration of group B ranged from 27.96 to 48.00 months with a mean of (37.56±10.68) month;and the follow-up duration of group C ranged from 24.00 to 66.00 months with a mean of (37.08±13.44) month. There were no significant differences in follow-up time among three groups(P>0.05). Six months after operation,Lysholm score 80.74±3.14 and IKDC score 79.92±3.44 in group A were higher than those in group B 80.74±3.14 and 78.21±4.63,and higher than those in group C 79.22±3.63 and 76.63±3.80(P<0.05);12 months after operation,Lysholm score 89.84±5.13 and IKDC score 87.90±3.93 in group A were higher than those in group B 85.74±6.04 and 83.62±5.64,and higher than those in group C 82.83±3.43 and 79.21±4.04(P<0.05).Conclusion: Compared with remnant-non-preserving group,the residual tissue of anterior cruciate ligament is preserved,which is conducive to promote the healing and remodeling of tendon graft and accelerate the recovery of joint function. Proper fixation of residual tissue and restoration of its tension are the key factors affecting the postoperative efficacy.