关节镜下解剖位与过顶位前交叉韧带单束重建的近期疗效对比

目的 比较关节镜下前交叉韧带(anterior cruciate ligament,ACL)解剖位单束(anatomic single-bundle,ASB)与传统过顶位单束(conventional over-the-top single-bundle,CSB)重建的近期临床疗效.方法 回顾分析2010年10月至2012年10月在我院关节外科接受ACL重建手术的病例及随访资料,按手术方式不同分为ASB组(n=31)和CSB组(n=32),移植韧带来源均为自体腘绳肌腱.比较两组患者在术后3～6个月的膝关节功能,评估方法采用膝关节主动活动度、Lachman试验、轴移试验、Lysholm评分及国际膝关节评分委员会(International Knee Documentation Committee,IKDC)评分.结果 术后膝关节主动活动度:CSB组3例术后膝关节伸直受限,平均5°～10°,ASB组无伸直受限,两组屈曲均正常;Lachman试验:ASB组全部阴性,CSB组6例阳性,差异有统计学意义(P＜0.05);轴移试验:ASB组阴性率为67.74％,CSB组阴性率为40.63％,差异有统计学意义(P＜0.05);Lysholm评分及IKDC评分差异均无统计学意义(均P＞0.05).结论 ACL的ASB重建术后早期能更好地恢复膝关节的前后及旋转稳定性,其临床意义及远期临床效果有待进一步研究.

Anatomic versus conventional over-the-top single-bundle in arthroscopic reconstruction of anterior cruciate ligament

Objective To compare the recent clinical results of the arthroscopic single-bundle ACL reconstruction with traditional over-the-top and anatomic femoral insertions..Method The curative results and follow-up data were retrospective analyzed in 63 cases with ACL injure which were treated with ACL reconstruction in Orthopedics of Tongji hospital of Huazhong University Of Science And Technology from October 2010 to October 2012 .All cases were performed single-bundle reconstruction with autogeneic hamstring tendons and divided into 2 groups according to surgical opinions as group of traditional over-the-top ACL reconstruction and group of anatomical ACL reconstruction.To compare and analyze the functions of knee after 3 to 6 months of operation respectively.The knee functions were evaluated by active joint flexion degree,Pivot shift test,Lachman test,IKDC and Lycholm scores.Results The active joint flexion degree:3 cases presented 5~10° extension limitation in CSB with no flexion limitation;no flexion limitation and extension limitation in ASB cases.Lachman test:all cases presented negative Lachman test after 3 to 6 months of operation in ASB;in CSB 6 cases presented Lachman test positive after 3 to 6 months of operation.Negative pivot shift was 66.7% in ASB vs 41.7% in CSB.Lysholm and IKDC scores increased significantly after operation, however, there''s no significance different between two groups on these two scores.Conclusion ASB reconstruction resulted in better anteroposterior and rotational stability than CSB reconstruction.However, these differences are small and may not be clinically relevant. So further follow-up clinical study are needed.