CAJ | 학술논문

目的比较膝关节前交叉韧带(ACL)损伤后,采用关节镜下自体腘绳肌腱早期重建与晚期重建ACL的临床疗效.方法回顾性分析2005年7月至2008年7月间采用自体腘绳肌腱重建ACL的95例ACL损伤患者资料,其中早期重建组(伤后2周内实施手术)31例,男21例,女10例;平均年龄为29.3岁.晚期重建组(伤后2～6个月实施手术)64例,男45例,女19例;平均年龄为31.5岁.两组患者的性别、年龄、术前Lysholm评分、国际膝关节文献委员会(IKDC)评定结果等术前指标差异无统计学意义(P>0.05),具有可比性.术后对患者进行体格检查,比较两组患者术后的疼痛消除时间、肿胀消除时间、恢复正常关节活动度(与健侧相同)的时间、Lysholm评分、IKDC评定结果等.结果早期重建组31例患者术后获平均22.4个月(8～32个月)随访.晚期重建组64例患者术后获平均21.5个月(11～33个月)随访.早期重建组疼痛消除时间[(35.6±3.2)d]、肿胀消除时间[(14.7±2.7)d]、恢复正常关节活动度时间[(48.8±4.8)d]均长于晚期重建组[(21.5±2.6)、(8.5±2.1)、(34.5±4.1)d],差异均有统计学意义(P<0.05).末次随访时膝关节IKDC评定结果:早期重建组A级12例,B级15例,C级4例;晚期重建组A级26例,B级29例,C级9例,两组比较差异无统计学意义(x~2=4.112,P=0.250).两组患者术后末次随访时Lysholm评分平均分别为(89.6±6.9)、(91.5±7.4)分,差异无统计学意义(t=0.677,P=0.500).结论早期重建与晚期重建ACL的近期临床疗效相近,但早期重建ACL者术后康复时间长于晚期重建者,远期疗效有待于进一步观察.
목적 비교슬관절전교차인대(ACL)손상후,채용관절경하자체객승기건조기중건여만기중건ACL적림상료효.방법 회고성분석2005년7월지2008년7월간채용자체객승기건중건ACL적95례ACL손상환자자료,기중조기중건조(상후2주내실시수술)31례,남21례,녀10례;평균년령위29.3세.만기중건조(상후2～6개월실시수술)64례,남45례,녀19례;평균년령위31.5세.량조환자적성별、년령、술전Lysholm평분、국제슬관절문헌위원회(IKDC)평정결과등술전지표차이무통계학의의(P>0.05),구유가비성.술후대환자진행체격검사,비교량조환자술후적동통소제시간、종창소제시간、회복정상관절활동도(여건측상동)적시간、Lysholm평분、IKDC평정결과등.결과 조기중건조31례환자술후획평균22.4개월(8～32개월)수방.만기중건조64례환자술후획평균21.5개월(11～33개월)수방.조기중건조동통소제시간[(35.6±3.2)d]、종창소제시간[(14.7±2.7)d]、회복정상관절활동도시간[(48.8±4.8)d]균장우만기중건조[(21.5±2.6)、(8.5±2.1)、(34.5±4.1)d],차이균유통계학의의(P<0.05).말차수방시슬관절IKDC평정결과:조기중건조A급12례,B급15례,C급4례;만기중건조A급26례,B급29례,C급9례,량조비교차이무통계학의의(x~2=4.112,P=0.250).량조환자술후말차수방시Lysholm평분평균분별위(89.6±6.9)、(91.5±7.4)분,차이무통계학의의(t=0.677,P=0.500).결론 조기중건여만기중건ACL적근기림상료효상근,단조기중건ACL자술후강복시간장우만기중건자,원기료효유대우진일보관찰.
Objective To compare the clinical outcomes of early reconstruction versus late reconstruction of anterior cruciate ligament(ACL)with hamstring tendon autograft.Methods From July 2005to July 2008,95 patients underwent ACL reconstruction with hamstring tendon autograft.Thirty-one cases received early reconstruction(2 weeks after injury)and 64 late reconstruction(2 to 6 months after injury).The clinical outcomes of the 2 groups were statistically compared(t and x~2 tests)in terms of physical examination results,time for pain and swelling relief,time for normal knee range of motion(ROM),International Knee Documentation Committee(IKDC)and Lysholm scores.Results The patients receiving early reconstruction and late reconstruction were followed up for an average duration of 22.4 months(8 to 32 months)and 21.5 months(11 to 33 months)respectively.No statistically significant differences were found in the IKDC and Lysholm scores between the 2 groups(P > 0.05),but early reconstruction group had significantly longer time for pain[[(35.6 ± 3.2)d vs.(21.5 ± 2.6)d]and swelling relief[(14.7 ± 2.7)d vs.(8.5 ±2.1)land for normal knee ROM[(48.8± 4.8)d vs.(34.5±4.1)d](P < 0.05).Conclusion Early and late ACL reconstructions may lead to similar clinical outcomes,but patients undergoing early reconstruction may need a longer period of rehabilitation.