前交叉韧带断裂的关节镜下保留残端重建手术治疗

目的]探讨关节镜下保留残端纤维前交叉韧带重建的手术方法及其与标准手术方法的疗效比较.方法]回顾性分析采用关节镜技术重建前交叉韧带293例,其中ACL完全断裂253例,男187例,女66例,平均年龄28岁.2004年5月～ 2007年12月,采用标准重建技术对85例ACL完全断裂患者进行关节镜下ACL重建手术,2007年1月～2010年5月,采用保留残端技术对168例ACL完全断裂患者进行关节镜下ACL重建手术.结果]在术后第12个月时有211例患者得到随访.Lachman试验:标准组患者术后阴性55例,弱阳性7例,阳性2例；保残组患者中132例阴性,10例弱阳性,阳性5例.采用两组比较秩和检验,P=0.438.通过Lysholm评分表对两组患者术前及术后患膝关节进行评分,标准组术后评分为90.84；保残组术后评分为92.09,两组评分相比,P=0.462.采用被动活动察觉阈值评估两组术后患膝本体感觉功能,标准组TTDPM(被动活动察觉阈值)为2.099°±0.159°,保残组TTDPM为1.683° ±0.218°,两组比较P=0.001,两组患者术后被动活动察觉阈值的差异具有统计学意义.结论]保留残端纤维关节镜下前交叉韧带重建,术后患者膝关节本体感觉功能恢复更好.

Arthroscopic anterior cruciate ligament reconstruction with remnant preserving technique

Objective] To explore the surgical technique of arthroscopic anterior cruciate ligament(ACL) reconstruction with remnant preserving technique and evaluate the clinical outcome compared to that of standard technique group.Method]Clinical data of 293 patients who received arthroscopic reconstruction of anterior cruciate ligament was analyzed retrospectively,253 cases were diagnosed of complete rupture of ACL.From May 2004 to December 2007,85 cases received arthroscopic ACL reconstruction through standard technique.From January 2007 to May 2010,168 cases received arthroscopic ACL reconstruction through remnant preserving technique.Result]A total of 211 cases were followed up at 12th month after surgery.In standard group,Lachman test was negative in 55 cases,weakly positive in 7 cases and positive in 2 cases.In remnant preserving group,Lachman test was negative in 132 cases,weakly positive in 10 cases and positive in 5 cases.Rank test was used to compare the Lachman test results between two groups(P=0.438).The knee function was evaluated according to the Lysholm scoring system before and after operation.In the standard group,the post-operative average score was 90.84.In the remnant preserving group,the post-operative average score was 92.09.Independent-samples t test was used to compare the post-operative score between two groups,the P value(post-operative score)=0.462.Threshold to detection of passive motion(TTDPM) was procured to evaluate the proprioceptive function of knee,the average TTDPM of standard group was 2.099°±0.159°,and the average TTDPM of remnant preserving group was 1.683°±0.218°,the P value=0.001,the difference of TTDPM between two groups was significant statistically.Conclusion]Arthroscopic ACL reconstruction with remnant preserving technique could facilitate the better recovery of knee proprioceptive function after surgery.