自体腘绳肌腱单束重建后交叉韧带移植物加用高强度编织线与否的临床对比研究

目的观察膝关节镜下自体腘绳肌腱单束重建后交叉韧带时移植物加用高强度编织缝线与否的临床疗效差异。方法回顾性分析中国医科大学附属盛京医院2017-2018年收治的40例后交叉韧带断裂并进行韧带重建患者临床资料,根据自体腘绳肌移植物中是否加用Arthrex AR-7200(Arthrex,Naples,FL,USA)编织缝线分为试验组(17例)和对照组(23例),以后抽屉试验(posterior drawer test,PDT)作为膝关节稳定性的评价标准,以IKDC评分、Lysholm评分、Tegner评分作为膝关节功能性评价标准,分别于术前及术后1年对两组患者进行评价,比较术后1年试验组与对照组膝关节评价结果,以及两组患者术后1年与术前膝关节评价结果。结果膝关节功能性方面:试验组术前及术后1年Lysholm评分以中位数(四分位数)表示,分别为64(40,81)、84(73,87)分,对照组分别为68(48,78)、80(70,90)分,组内手术前、后比较差异均有统计学意义(Z值分别为-2.535、-3.576,P值分别为0.011、<0.001);而组间比较差异均无统计学意义(P均>0.05)。试验组术前及术后1年Tegner评分以中位数四分位数]表示,分别为2.0(1.0,2.5)、6.0(5.0,7.5)分,对照组分别为2.0(1.0,3.0)、6.0(4.0,7.0)分,组内手术前、后比较差异均有统计学意义(Z值分别为-3.397、-4.122,P均<0.001);而组间比较差异均无统计学意义(P均>0.05)。术后1年两组患者IKDC评分均较术前有显著改善(Z值分别为-3.750,-4.234,P均<0.001),而组间比较差异无统计学意义(P>0.05)。术前两组患者膝关节后抽屉试验比较差异无统计学意义(P>0.05);术后1年两组患者膝关节稳定性均较术前有显著改善(Z值分别为-3.674,-4.083,P均<0.01),并且试验组膝关节稳定性显著优于对照组(Z=0.156,P=0.039)。结论自体腘绳肌重建后交叉韧带可取得令人满意的临床疗效,并且在移植物中放置高强度编织缝线更利于膝关节稳定性的恢复。

A clinical comparative study on the reconstruction of posterior cruciate ligament with single tendon autograft plus high-strength braid or not

Objective To observe the difference of the clinical effect of using high-strength woven suture or not in the reconstruction of posterior cruciate ligament(PCL)with single tendon autograft under arthroscope.Methods The clinical data of 40 patients with posterior cruciate ligament rupture and ligament reconstruction admitted to Shengjing Hospital Affiliated to China Medical University from 2017 to 2018 were analyzed retrospectively.According to whether or not to add Arthrex ar-7200(Arthrex,Naples,FL,USA)braided suture in the autogenous hamstring graft,the patients were divided into test group(17 cases)and control group(23 cases).The posterior drawer test(PDT)was used as the knee joint stability test to evaluate the knee function,IKDC score,Lysholm score and Tegner score were used as the evaluation criteria.The evaluation results of the knee joint in the experimental group and the control group were compared before and one year after the operation,and the evaluation results of the knee joint in the two groups were compared one year after the operation and one year before the operation Results Functional aspects of knee joint:The Lysholm score of the experimental group was expressed by median(quartile)1 year before and after operation.Lysholm scores of the trail group were 64(40,81)and 84(73,87)preoperative and postoperative,respectively,the control group were 68(48,78)and 80(70,90)respectively,there was statistically difference before and after surgery(Z value was-2.535 and-3.576,P value was 0.011 and<0.001,respectively).There was no statistically significant difference between groups(all P>0.05).The Tegner score of the experimental group before and 1 year after operation was expressed as the medianquartile],which was 2.0(1.0,2.5),6.0(5.0,7.5)respectively,and that of the control group was 2.0(1.0,3.0),6.0(4.0,7.0)respectively.There was statistically significant difference between the two groups before and after operation(Z value was-3.397,-4.122,all P<0.001),but there was no statistically significant difference between the two groups(all P>0.05).One year after operation,the IKDC scores of the two groups were significantly improved(Z values were-3.750,-4.234,all P<0.001),but there was no significant difference between the two groups(P>0.05).There was no significant difference between the two groups in the postoperative drawer test(P>0.05);one year after the operation,the stability of the two groups was significantly improved(Z values were-3.674,-4.083,all P<0.01),and the stability of the experimental group was significantly better than that of the control group(Z=0.156,P=0.039).Conclusion Posterior cruciate ligament reconstruction with autologous hamstring muscle can achieve satisfactory clinical results,and placing high-strength braided sutures in the graft is more conducive to the recovery of knee joint stability.