中华创伤骨科杂志
中華創傷骨科雜誌
중화창상골과잡지
CHINESE JOURNAL OF ORTHOPAEDIC TRAUMA
2011年
9期
840-844
,共5页
陈哲峰%王青%郭敦明%范卫民
陳哲峰%王青%郭敦明%範衛民
진철봉%왕청%곽돈명%범위민
前交叉韧带%关节镜检查%前内侧束
前交扠韌帶%關節鏡檢查%前內側束
전교차인대%관절경검사%전내측속
Anterior cruciate ligament%Arthroscopy%Anteromedial bundle
目的探讨关节镜下前交叉韧带(ACL)前内侧束断裂的重建方法及疗效。 方法 2004年5月至2010年5月采用关节镜技术重建293例ACL损伤患者，其中40例(13.7％)患者术中关节镜下诊断为ACL前内侧束断裂，男34例，女6例；年龄18～39岁，平均30.1岁。受伤至手术时间平均为4.2个月（7 d至8个月）。术中保留ACL后外侧束，使用自体4股腘绳肌腱重建前内侧束。术前及术后随访评估包括临床查体和Lysholm评分，本体感觉功能采用被动活动察觉阈值进行评估。 结果 40例患者术后获平均33个月（7～56个月）随访。膝关节Lysholm评分术前平均为(56.7±8.6)分，末次随访时平均为(92.0±5.0)分，差异有统计学意义(t=27. 750，P=0.000)。末次随访时按Lysholm评分评定疗效：优19例，良16例，可5例，优良率为87.5％。Lachman试验阴性34例，弱阳性4例，阳性2例。末次随访时患膝被动活动察觉阈值平均为2.12°±0.15°，健膝被动活动察觉阈值平均为2.09°±0. 16°，差异无统计学意义（t=0. 657,P=0.515）。术后所有患者均恢复日常工作，关节稳定性明显改善。结论关节镜下单束重建ACL前内侧束，术中保留了后外侧束，有利于隧道的精确定位和移植物固定机械强度的增加，并能加速移植肌腱的血管化和再神经支配，促进膝关节功能尽快恢复。
目的探討關節鏡下前交扠韌帶(ACL)前內側束斷裂的重建方法及療效。 方法 2004年5月至2010年5月採用關節鏡技術重建293例ACL損傷患者，其中40例(13.7％)患者術中關節鏡下診斷為ACL前內側束斷裂，男34例，女6例；年齡18～39歲，平均30.1歲。受傷至手術時間平均為4.2箇月（7 d至8箇月）。術中保留ACL後外側束，使用自體4股腘繩肌腱重建前內側束。術前及術後隨訪評估包括臨床查體和Lysholm評分，本體感覺功能採用被動活動察覺閾值進行評估。 結果 40例患者術後穫平均33箇月（7～56箇月）隨訪。膝關節Lysholm評分術前平均為(56.7±8.6)分，末次隨訪時平均為(92.0±5.0)分，差異有統計學意義(t=27. 750，P=0.000)。末次隨訪時按Lysholm評分評定療效：優19例，良16例，可5例，優良率為87.5％。Lachman試驗陰性34例，弱暘性4例，暘性2例。末次隨訪時患膝被動活動察覺閾值平均為2.12°±0.15°，健膝被動活動察覺閾值平均為2.09°±0. 16°，差異無統計學意義（t=0. 657,P=0.515）。術後所有患者均恢複日常工作，關節穩定性明顯改善。結論關節鏡下單束重建ACL前內側束，術中保留瞭後外側束，有利于隧道的精確定位和移植物固定機械彊度的增加，併能加速移植肌腱的血管化和再神經支配，促進膝關節功能儘快恢複。
목적탐토관절경하전교차인대(ACL)전내측속단렬적중건방법급료효。 방법 2004년5월지2010년5월채용관절경기술중건293례ACL손상환자，기중40례(13.7％)환자술중관절경하진단위ACL전내측속단렬，남34례，녀6례；년령18～39세，평균30.1세。수상지수술시간평균위4.2개월（7 d지8개월）。술중보류ACL후외측속，사용자체4고객승기건중건전내측속。술전급술후수방평고포괄림상사체화Lysholm평분，본체감각공능채용피동활동찰각역치진행평고。 결과 40례환자술후획평균33개월（7～56개월）수방。슬관절Lysholm평분술전평균위(56.7±8.6)분，말차수방시평균위(92.0±5.0)분，차이유통계학의의(t=27. 750，P=0.000)。말차수방시안Lysholm평분평정료효：우19례，량16례，가5례，우량솔위87.5％。Lachman시험음성34례，약양성4례，양성2례。말차수방시환슬피동활동찰각역치평균위2.12°±0.15°，건슬피동활동찰각역치평균위2.09°±0. 16°，차이무통계학의의（t=0. 657,P=0.515）。술후소유환자균회복일상공작，관절은정성명현개선。결론관절경하단속중건ACL전내측속，술중보류료후외측속，유리우수도적정학정위화이식물고정궤계강도적증가，병능가속이식기건적혈관화화재신경지배，촉진슬관절공능진쾌회복。
ObjectiveTo explore the surgical techniques and therapeutic effects of arthroscopic reconstruction of the ruptured anteromedial bundle of anterior cruciate ligament (ACL).MethodsFrom May 2004 to May 2010, 293 patients received arthroscopic ACL reconstruction at our department. Of them,40 cases (13.7％ ) were diagnosed as anteromedial bundle rupture of ACL during arthroscopic exploration.The ruptured anteromedial bundle was reconstructed using the autologous quadrupled hamstring graft while the posterolateral bundle was preserved during the procedure. Lysholm scoring and Lachman test were performed prior to and after the reconstruction to evaluate functional recovery of the knee. The proprioceptive function of the knee was evaluated by Threshold to Detection of Passive Motion (TDPM) system.ResultsAll the cases of ruptured anteromedial bundle were followed up for an average of 33 months (from 7 to 56 months).The average Lysholm score was 56.7 ± 8.6 before surgery and 92. 0 ± 5.0 at the last follow-up, with a significant difference ( t =27. 750, P =0. 000). By Lysholm scoring at the last follow-up, 19 patients were rated as excellent, 16 as good, 5 as fair and none as poor, with an excellent-to-good rate of 87. 5％. By the Lachman test, 34 patients were negative, 4 weakly positive and 2 positive. At the last follow-up, there was no significant difference between the average TDPM of the affected knees (2. 12° ±- 0. 15°) and that of the contralateral knees (2. 09° ±0. 16°) (t =0. 657, P =0. 515) . All the patients resumed normal activities after surgery with obviously improved stability of the knee.ConclusionArthroscopic reconstruction of the ruptured anteromedial bundle of ACL with preservation of the posterolateral bundle can help precise positioning of the bone tunnel, provide additional mechanical strength for graft fixation, and accelerate revascularization and sensory reinnervation of the reconstructed ACL.
