中国骨与关节杂志
中國骨與關節雜誌
중국골여관절잡지
Chinese Journal of Bone and Joint
2014年
1期
38-44
,共7页
史福东%左金增%刘仕杰%张勇%刘田虹%武强%马海洋%王雪臣%李长江
史福東%左金增%劉仕傑%張勇%劉田虹%武彊%馬海洋%王雪臣%李長江
사복동%좌금증%류사걸%장용%류전홍%무강%마해양%왕설신%리장강
前交叉韧带%内侧副韧带%关节镜%带线锚钉%腓骨长肌腱
前交扠韌帶%內側副韌帶%關節鏡%帶線錨釘%腓骨長肌腱
전교차인대%내측부인대%관절경%대선묘정%비골장기건
Anterior cruciate ligament ( ACL )%Medial collateral ligament ( MCL )%Arthroscope%Suture anchor%Peroneus longus tendon
目的：探讨腓骨长肌腱重建(anteriorcruciateligament，ACL)结合一期锚钉修复严重(medial collateralligament，MCL)损伤的早期疗效。方法2008年12月至2012年10月，关节镜下自体同侧腓骨长肌腱和同种异体半腱肌腱重建急性 ACL 断裂合并 III 度 MCL 损伤38例。其中 ACL 用自体同侧腓骨长肌腱重建18例( A组)，同种异体半腱肌腱重建20例( B组)，MCL均用带线锚钉固定。术后伸直位支具制动后1周开始练习膝关节屈伸，屈曲角度由小到大，至术后6周至少达到120度。所有患者均进行术后6个月、术后1年客观指标检查，包括膝关节稳定性( KT-1000测量，134 N前向拉力)，Lachman试验，轴移试验，大腿周径差别，膝关节磁共振检查；并应用 Tegner 评分表，Lysholm 评分表和 IKDC 膝关节功能评分表对患者运动功能进行主观评估。术前和术后分别进行足部16排CT扫描重建，测量足部横弓的宽度以及内、外纵弓的高度和顶角。将以上结果进行对比。结果术前Tegner评分，Lysholm评分 P值均＞0.05，差异无统计学意义。术后6个月Lachman试验检查A组16例(88.89％)阴性，2例(11.11%) I度阳性，无II度以上阳性；B组17例(85.00％)阴性，3例(15.00％) I度阳性，无II度以上阳性。A组有1例轴移试验阳性，其余均为阴性；B组有1例轴移试验阳性，其余均为阴性。KT-1000在134 N前向拉力下测量的双侧膝关节前向松弛度差异，A组：＜2 mm者15例(83.33%)，～5 mm者3例(16.67%)，无＞5 mm者(0.00%)；B组：＜2 mm者16例(80.00%)，～5 mm者3例(15.00%)，＞5 mm者1例(5.00%)。双下肢周径差别A组为(1.06±0.86) cm，B组为(1.04±0.92) cm。Tegner评分A组为(6.00±0.46)分，B组为(6.00±0.57)分。Lysholm 评分 A 组为(94.00±6.02)分，B 组为(95.00±2.35)分。IKDC 膝关节功能评分 A 组为(89.45±2.89)分，B组为(90.12±4.56)分。两组患者各指标间差异均无统计学意义( P＞0.05)。术后1年Lachman试验检查A组15例(83.33％)阴性，3例(16.67%) I度阳性，无II度以上阳性；B组16例(80.00％)阴性，1例(5.00％) I度阳性，2例(10.00％) II度阳性。A组有2例轴移试验阳性，其余患者均为阴性；B组有2例轴移试验阳性，其余患者均为阴性。KT-1000在134 N 前向拉力下测量的双侧膝关节前向松弛度差异，A组：＜2 mm者14例(77.78%)，～5 mm者4例(22.22%)，无＞5 mm者(0.00%)；B组：＜2 mm者16例(80.00%)，～5 mm者3例(15.00%)，＞5 mm者1例(5.00%) mm。双下肢周径差别A组为(1.01±0.21) cm，B组为(1.03±0.12) cm。Tegner评分A组为(5.00±0.96)分，B组为(6.00±0.03)分。Lysholm评分A组为(94.00±6.67)分，B组为(95.00±3.55)分。IKDC膝关节功能评分A组为(90.48±2.36)分，B组为(90.17±4.32)分。两组患者各指标间差异均无统计学意义( P＞0.05)。术后经过平均18个月的随访，16排CT测量结果显示手术前后足部横弓的宽度以及内、外纵弓的高度和顶角无显著性差异。结论急性ACL断裂合并III度MCL损伤时，应用自体同侧腓骨长肌腱和同种异体半腱肌腱重建ACL结合一期锚钉修复III度MCL损伤，均能取得优良的早期疗效，两者的差异无统计学意义。自体同侧腓骨长肌腱是合并III度MCL损伤时前交叉韧带断裂重建可选择的良好移植物，同时行一期带线锚钉修复MCL损伤的早期疗效可靠。
目的：探討腓骨長肌腱重建(anteriorcruciateligament，ACL)結閤一期錨釘脩複嚴重(medial collateralligament，MCL)損傷的早期療效。方法2008年12月至2012年10月，關節鏡下自體同側腓骨長肌腱和同種異體半腱肌腱重建急性 ACL 斷裂閤併 III 度 MCL 損傷38例。其中 ACL 用自體同側腓骨長肌腱重建18例( A組)，同種異體半腱肌腱重建20例( B組)，MCL均用帶線錨釘固定。術後伸直位支具製動後1週開始練習膝關節屈伸，屈麯角度由小到大，至術後6週至少達到120度。所有患者均進行術後6箇月、術後1年客觀指標檢查，包括膝關節穩定性( KT-1000測量，134 N前嚮拉力)，Lachman試驗，軸移試驗，大腿週徑差彆，膝關節磁共振檢查；併應用 Tegner 評分錶，Lysholm 評分錶和 IKDC 膝關節功能評分錶對患者運動功能進行主觀評估。術前和術後分彆進行足部16排CT掃描重建，測量足部橫弓的寬度以及內、外縱弓的高度和頂角。將以上結果進行對比。結果術前Tegner評分，Lysholm評分 P值均＞0.05，差異無統計學意義。術後6箇月Lachman試驗檢查A組16例(88.89％)陰性，2例(11.11%) I度暘性，無II度以上暘性；B組17例(85.00％)陰性，3例(15.00％) I度暘性，無II度以上暘性。A組有1例軸移試驗暘性，其餘均為陰性；B組有1例軸移試驗暘性，其餘均為陰性。KT-1000在134 N前嚮拉力下測量的雙側膝關節前嚮鬆弛度差異，A組：＜2 mm者15例(83.33%)，～5 mm者3例(16.67%)，無＞5 mm者(0.00%)；B組：＜2 mm者16例(80.00%)，～5 mm者3例(15.00%)，＞5 mm者1例(5.00%)。雙下肢週徑差彆A組為(1.06±0.86) cm，B組為(1.04±0.92) cm。Tegner評分A組為(6.00±0.46)分，B組為(6.00±0.57)分。Lysholm 評分 A 組為(94.00±6.02)分，B 組為(95.00±2.35)分。IKDC 膝關節功能評分 A 組為(89.45±2.89)分，B組為(90.12±4.56)分。兩組患者各指標間差異均無統計學意義( P＞0.05)。術後1年Lachman試驗檢查A組15例(83.33％)陰性，3例(16.67%) I度暘性，無II度以上暘性；B組16例(80.00％)陰性，1例(5.00％) I度暘性，2例(10.00％) II度暘性。A組有2例軸移試驗暘性，其餘患者均為陰性；B組有2例軸移試驗暘性，其餘患者均為陰性。KT-1000在134 N 前嚮拉力下測量的雙側膝關節前嚮鬆弛度差異，A組：＜2 mm者14例(77.78%)，～5 mm者4例(22.22%)，無＞5 mm者(0.00%)；B組：＜2 mm者16例(80.00%)，～5 mm者3例(15.00%)，＞5 mm者1例(5.00%) mm。雙下肢週徑差彆A組為(1.01±0.21) cm，B組為(1.03±0.12) cm。Tegner評分A組為(5.00±0.96)分，B組為(6.00±0.03)分。Lysholm評分A組為(94.00±6.67)分，B組為(95.00±3.55)分。IKDC膝關節功能評分A組為(90.48±2.36)分，B組為(90.17±4.32)分。兩組患者各指標間差異均無統計學意義( P＞0.05)。術後經過平均18箇月的隨訪，16排CT測量結果顯示手術前後足部橫弓的寬度以及內、外縱弓的高度和頂角無顯著性差異。結論急性ACL斷裂閤併III度MCL損傷時，應用自體同側腓骨長肌腱和同種異體半腱肌腱重建ACL結閤一期錨釘脩複III度MCL損傷，均能取得優良的早期療效，兩者的差異無統計學意義。自體同側腓骨長肌腱是閤併III度MCL損傷時前交扠韌帶斷裂重建可選擇的良好移植物，同時行一期帶線錨釘脩複MCL損傷的早期療效可靠。
목적：탐토비골장기건중건(anteriorcruciateligament，ACL)결합일기묘정수복엄중(medial collateralligament，MCL)손상적조기료효。방법2008년12월지2012년10월，관절경하자체동측비골장기건화동충이체반건기건중건급성 ACL 단렬합병 III 도 MCL 손상38례。기중 ACL 용자체동측비골장기건중건18례( A조)，동충이체반건기건중건20례( B조)，MCL균용대선묘정고정。술후신직위지구제동후1주개시연습슬관절굴신，굴곡각도유소도대，지술후6주지소체도120도。소유환자균진행술후6개월、술후1년객관지표검사，포괄슬관절은정성( KT-1000측량，134 N전향랍력)，Lachman시험，축이시험，대퇴주경차별，슬관절자공진검사；병응용 Tegner 평분표，Lysholm 평분표화 IKDC 슬관절공능평분표대환자운동공능진행주관평고。술전화술후분별진행족부16배CT소묘중건，측량족부횡궁적관도이급내、외종궁적고도화정각。장이상결과진행대비。결과술전Tegner평분，Lysholm평분 P치균＞0.05，차이무통계학의의。술후6개월Lachman시험검사A조16례(88.89％)음성，2례(11.11%) I도양성，무II도이상양성；B조17례(85.00％)음성，3례(15.00％) I도양성，무II도이상양성。A조유1례축이시험양성，기여균위음성；B조유1례축이시험양성，기여균위음성。KT-1000재134 N전향랍력하측량적쌍측슬관절전향송이도차이，A조：＜2 mm자15례(83.33%)，～5 mm자3례(16.67%)，무＞5 mm자(0.00%)；B조：＜2 mm자16례(80.00%)，～5 mm자3례(15.00%)，＞5 mm자1례(5.00%)。쌍하지주경차별A조위(1.06±0.86) cm，B조위(1.04±0.92) cm。Tegner평분A조위(6.00±0.46)분，B조위(6.00±0.57)분。Lysholm 평분 A 조위(94.00±6.02)분，B 조위(95.00±2.35)분。IKDC 슬관절공능평분 A 조위(89.45±2.89)분，B조위(90.12±4.56)분。량조환자각지표간차이균무통계학의의( P＞0.05)。술후1년Lachman시험검사A조15례(83.33％)음성，3례(16.67%) I도양성，무II도이상양성；B조16례(80.00％)음성，1례(5.00％) I도양성，2례(10.00％) II도양성。A조유2례축이시험양성，기여환자균위음성；B조유2례축이시험양성，기여환자균위음성。KT-1000재134 N 전향랍력하측량적쌍측슬관절전향송이도차이，A조：＜2 mm자14례(77.78%)，～5 mm자4례(22.22%)，무＞5 mm자(0.00%)；B조：＜2 mm자16례(80.00%)，～5 mm자3례(15.00%)，＞5 mm자1례(5.00%) mm。쌍하지주경차별A조위(1.01±0.21) cm，B조위(1.03±0.12) cm。Tegner평분A조위(5.00±0.96)분，B조위(6.00±0.03)분。Lysholm평분A조위(94.00±6.67)분，B조위(95.00±3.55)분。IKDC슬관절공능평분A조위(90.48±2.36)분，B조위(90.17±4.32)분。량조환자각지표간차이균무통계학의의( P＞0.05)。술후경과평균18개월적수방，16배CT측량결과현시수술전후족부횡궁적관도이급내、외종궁적고도화정각무현저성차이。결론급성ACL단렬합병III도MCL손상시，응용자체동측비골장기건화동충이체반건기건중건ACL결합일기묘정수복III도MCL손상，균능취득우량적조기료효，량자적차이무통계학의의。자체동측비골장기건시합병III도MCL손상시전교차인대단렬중건가선택적량호이식물，동시행일기대선묘정수복MCL손상적조기료효가고。
Objective To investigate the early curative effects of anterior cruciate ligament ( ACL ) reconstruction with the peroneus longus tendon combined with one-stage repair of severe medial collateral ligament ( MCL ) injury using suture anchors.Methods From December 2008 to October 2012, a total of 38 patients with acute ACL tears and grade III MCL injuries underwent arthroscopic reconstruction with the ipsilateral autologous peroneus longus tendon and the semitendinosus allograft. There were 18 cases of ACL reconstruction with the ipsilateral autologous peroneus longus tendon ( group A ) and 20 cases with the semitendinosus allograft ( group B ). The suture anchors were used in all cases of MCL injuries. After the postoperative brace immobilization in the straight position for 1 week, the patients began the practice of knee lfexion and extension. The lfexion angle was gradually increased, and 6 weeks after the operation it reached more than 120 degrees. All patients were examined in the following objective indexes at 6 and 12 months after the operation respectively, including the stability of the knee ( KT-1000, 134 N forward tension ), Lachman test, pivot shift test, thigh circumference difference and knee Magnetic Resonance Imaging ( MRI ). Subjective evaluation of the motor functions in the patients was performed using the Tegner scale, Lysholm scale and International Knee Documentation Committee ( IKDC ) knee function scale. Reconstruction was performed in the foot with a 16-slice CT scanner preoperatively and postoperatively. The width of the transverse arch of the foot and the height and apex angel of the inner and outer longitudinal arches were measured. The above results were compared.Results Based on the preoperative Tegner scores and Lysholm scores, P values were more than 0.05 and the differences were not statistically signiifcant. The Lachman test was negative in 16 cases ( 88.89% ) in the 6th months after the operation and I positive in 2 cases ( 11.11% ) in group A, with no positive cases of more than II degrees. It was negative in 17 cases ( 85.00% ) and I positive in 3 cases ( 15.00% ) in group B, with no positive cases of more than II degrees. The pivot shift test was positive in 1 case in group A, and negative in all the other cases. It was positive in 1 case in group B, and negative in all the other cases. The KT-1000 examination with the forward tension of 134 N showed that the side to side difference of anterior laxity was less than 2 mm in 15 cases ( 88.33% ) and -5 mm in 3 cases ( 16.67% ) in group A, with no cases of more than 5 mm ( 0.00% ). It was less than 2 mm in 16 cases ( 80.00% ), -5 mm in 3 cases ( 15.00% ) and more than 5 mm in 1 case ( 5.00% ) in group B. The circumference differences of both lower limbs were ( 1.06±0.86 ) cm in group A and ( 1.04±0.92 ) cm in group B. The Tegner scores were ( 6.00±0.46 ) points in group A and ( 6.00±0.57 ) points in group B. The Lysholm scores were ( 94.00±6.02 ) points in group A and ( 95.00±2.35 ) points in group B. The IKDC knee function scores were ( 89.45±2.89 ) points in group A and ( 90.12±4.56 ) points in group B. The differences in each index between the 2 groups were not statistically signiifcant (P>0.05 ). At 1 year after the operation, the Lachman test was negative in 15 cases ( 83.33% ) and I positive in 3 cases ( 16.67% ) in group A, with no positive cases of more than II degrees. It was negative in 16 cases ( 80.00% ), I positive in 1 case ( 5.00% ) and II positive in 2 cases ( 10.00% ) in group B. The pivot shift test was positive in 2 cases in group A, and negative in all the other cases. It was positive in 2 cases in group B, and negative in all the other cases. The KT-1000 examination with the forward tension of 134N showed that the side to side difference of anterior laxity was less than 2 mm in 14 cases ( 77.78% ) and -5 mm in 4 cases ( 22.22% ) in group A, with no cases of more than 5 mm ( 0.00% ). It was less than 2 mm in 16 cases ( 80.00% ), -5 mm in 3 cases ( 15.00% ) and more than 5 mm in 1 case ( 5.00% ) in group B. The circumference differences of both lower limbs were ( 1.01±0.21 ) cm in group A and ( 1.03±0.12 ) cm in group B. The Tegner scores were ( 5.00±0.96 ) points in group A and ( 6.00±0.03 ) points in group B. The Lysholm scores were ( 94.00±6.67 ) points in group A and ( 95.00± 3.55 ) points in group B. The IKDC knee function scores were ( 90.48±2.36 ) points in group A and ( 90.17±4.32 ) points in group B. The differences in each index between the 2 groups were not statistically signiifcant (P>0.05 ). After a mean follow-up of 18 months, the measurement results by the 16-slice CT scanner showed that there were not statistically signiifcant differences in the width of the transverse arch and the height and apex angel of the inner and outer longitudinal arches of the foot before and after the operation.Conclusions For the patients with acute ACL tears and grade III MCL injuries, satisfactory early results can be obtained after the ACL reconstruction with the ipsilateral autologous peroneus longus tendon and the semitendinosus allograft combined with the one-stage repair of MCL injury using suture anchors are performed. There are no statistically significant differences between them. The ipsilateral autologous peroneus longus tendon may be a good choice in the ACL reconstruction when grade III MCL injury occur. The early results are good at the same time with the one-stage repair of MCL injuries using suture anchors.
