CAJ | 학술논문

目的：在关节镜下膝关节前交叉韧带重建术中股骨端采用可吸收挤压螺钉（bioabsorbable inrerferrencs screws，BS）与带袢钢板（endobutton）固定韧带，评价两者的疗效差异．方法：收集通辽市医院2005-01-2011-01间治疗的有前交叉韧带断裂的患者资料57例，进行回顾分析，其中45例为男性，12例为女性，年龄16岁-57岁（平均年龄27．7岁）；病程最少3天，最长12年，平均18．7月．全部患者均有明确外伤史，其中12例患者为车祸中受伤，另外30例患者为膝关节扭伤，其他15例为膝关节跌伤．其中有47例是伴有不同程度的膝关节不稳症状患者；术前体格检查，有54例前抽屉试验（＋），12例外翻试验（＋），Lachman试验（＋）患者38例，轴移试验（＋）24例．在关节镜辅助下行交叉韧带重建术，术后指导患者常规康复锻炼，应用Lysholm评分评价2组患者手术前后膝关节功能，并进行对比，运用统计学方法分析两种固定物固定交叉韧带的疗效的差别．结果：通过对所有病例长达1年的随访．术后两组患者膝关节不稳症状均缓解，体格检查关节前、后抽屉试验、轴移试验、Lachman试验均为（-）．对两组患者行膝关节Lysholm评分，应用挤压螺钉固定的患者共34人，术前评分：17-71分（平均42．51±14．90），术后1年评分：85-100（平均96．69±3．63）；使用带袢钢板固定的患者共23人，术前评分：18—79分（平均44．12±14．26），术后1年评分89-100（平均97．24±3．20）．采用t检验分析，挤压螺钉组患者术前、术后评分差异有统计学意义（P〈0．05）；带袢钢板组患者术前、术后评分有统计学差异（P〈0．05），术后1年评分挤压螺钉组与带袢钢板组患者无统计学差异（P〉0．05）．结论：应用关节镜辅助行膝关节前交叉韧带重建术，采用挤压螺钉与带袢钢板两种方式固定韧带股骨端，均能改善患者症状，显著的重建患者膝关节稳定性，在临床疗效上，两者之间并无统计学差异，对于前交叉韧带固定来说，两者均属于可靠的固定方法．目的：在關節鏡下膝關節前交扠韌帶重建術中股骨耑採用可吸收擠壓螺釘（bioabsorbable inrerferrencs screws，BS）與帶袢鋼闆（endobutton）固定韌帶，評價兩者的療效差異．方法：收集通遼市醫院2005-01-2011-01間治療的有前交扠韌帶斷裂的患者資料57例，進行迴顧分析，其中45例為男性，12例為女性，年齡16歲-57歲（平均年齡27．7歲）；病程最少3天，最長12年，平均18．7月．全部患者均有明確外傷史，其中12例患者為車禍中受傷，另外30例患者為膝關節扭傷，其他15例為膝關節跌傷．其中有47例是伴有不同程度的膝關節不穩癥狀患者；術前體格檢查，有54例前抽屜試驗（＋），12例外翻試驗（＋），Lachman試驗（＋）患者38例，軸移試驗（＋）24例．在關節鏡輔助下行交扠韌帶重建術，術後指導患者常規康複鍛煉，應用Lysholm評分評價2組患者手術前後膝關節功能，併進行對比，運用統計學方法分析兩種固定物固定交扠韌帶的療效的差彆．結果：通過對所有病例長達1年的隨訪．術後兩組患者膝關節不穩癥狀均緩解，體格檢查關節前、後抽屜試驗、軸移試驗、Lachman試驗均為（-）．對兩組患者行膝關節Lysholm評分，應用擠壓螺釘固定的患者共34人，術前評分：17-71分（平均42．51±14．90），術後1年評分：85-100（平均96．69±3．63）；使用帶袢鋼闆固定的患者共23人，術前評分：18—79分（平均44．12±14．26），術後1年評分89-100（平均97．24±3．20）．採用t檢驗分析，擠壓螺釘組患者術前、術後評分差異有統計學意義（P〈0．05）；帶袢鋼闆組患者術前、術後評分有統計學差異（P〈0．05），術後1年評分擠壓螺釘組與帶袢鋼闆組患者無統計學差異（P〉0．05）．結論：應用關節鏡輔助行膝關節前交扠韌帶重建術，採用擠壓螺釘與帶袢鋼闆兩種方式固定韌帶股骨耑，均能改善患者癥狀，顯著的重建患者膝關節穩定性，在臨床療效上，兩者之間併無統計學差異，對于前交扠韌帶固定來說，兩者均屬于可靠的固定方法．
목적：재관절경하슬관절전교차인대중건술중고골단채용가흡수제압라정（bioabsorbable inrerferrencs screws，BS）여대번강판（endobutton）고정인대，평개량자적료효차이．방법：수집통료시의원2005-01-2011-01간치료적유전교차인대단렬적환자자료57례，진행회고분석，기중45례위남성，12례위녀성，년령16세-57세（평균년령27．7세）；병정최소3천，최장12년，평균18．7월．전부환자균유명학외상사，기중12례환자위차화중수상，령외30례환자위슬관절뉴상，기타15례위슬관절질상．기중유47례시반유불동정도적슬관절불은증상환자；술전체격검사，유54례전추체시험（＋），12예외번시험（＋），Lachman시험（＋）환자38례，축이시험（＋）24례．재관절경보조하행교차인대중건술，술후지도환자상규강복단련，응용Lysholm평분평개2조환자수술전후슬관절공능，병진행대비，운용통계학방법분석량충고정물고정교차인대적료효적차별．결과：통과대소유병례장체1년적수방．술후량조환자슬관절불은증상균완해，체격검사관절전、후추체시험、축이시험、Lachman시험균위（-）．대량조환자행슬관절Lysholm평분，응용제압라정고정적환자공34인，술전평분：17-71분（평균42．51±14．90），술후1년평분：85-100（평균96．69±3．63）；사용대번강판고정적환자공23인，술전평분：18—79분（평균44．12±14．26），술후1년평분89-100（평균97．24±3．20）．채용t검험분석，제압라정조환자술전、술후평분차이유통계학의의（P〈0．05）；대번강판조환자술전、술후평분유통계학차이（P〈0．05），술후1년평분제압라정조여대번강판조환자무통계학차이（P〉0．05）．결론：응용관절경보조행슬관절전교차인대중건술，채용제압라정여대번강판량충방식고정인대고골단，균능개선환자증상，현저적중건환자슬관절은정성，재림상료효상，량자지간병무통계학차이，대우전교차인대고정래설，량자균속우가고적고정방법．
Objective:To evaluate the difference between bioabsorbable inrerferrences screws(BS) and endobutton on ligament fixation in anterior cruciate ligament reconstruction at the thighbone under arthroscopy. Methods: 57 patients with broken anterior cruciate ligament, who were treated in the hospital from 2005-01-2011-01, were reviewed and analyzed. There were 45 males and 12 females with the average age of 27.7(range 16-55 years old). The disease duration was 3 clays to 12 years and the average was 18.7 months. All the patients were evidently injured, of which 12 patients were traffic accident injuries, 30 patients were knee joint sprain and other 15 patients were knee joint tumble, and 47 cases among all the cases had unstable symptom of knee joints in varying degrees. The physical test before operation showed: 54 cases had positive anterior drawer test, 12 cases had positive external-rotation test, 38 cases had positive Laehman test and 24 cases had positive Plovot shift test. Cruciate ligament reconstruction under arthroscopy was done and routine recovery practice was made after operation. Applying Lysholm scorse to eveluate knee joint function before and after operation of the two groups, and through comparing the scorses to analyse the difference of clinical effect of the two fixations on fixing cruciate ligament by using a statistical way. Results: After the patients were followed up for a year, two group patients' unstable symptoms of knee joint were relieved and physical test showed that the anterior and posterior drawer tests, Plovot shift test, and Lachman test were all negative. Lysholm scores of knee joint of two groups showed that, for 34 patients with inrerferrences screws, the scores before operation were 17-71(average 42.51 ± 14.90), the scores after operation were 84-100(average 97.24 ± 3.63), for 23 patients with endobutton, the scores before operation were 18-79(average 44.12 ± 14.26), the scores after operation were 89- 100(average 97.24 ± 3.20). The results of T test analysis showed that the difference of scores of the patients with inrerferrences screws had statistical significance after and before operation(P〈0.05), the scores of patients with endobutton also had statistical significance(P〈0.05). One year after operation, the scores of the patients with inrerferrences screws and the ones with endobutton were not statistically different(P〈0.05). Conclusion: Using inrerferrences screws and endobutton to fix ligament thighbone in anterior cruciate ligament reconstruction under arthroscopy, the patients' symptom can be improved, the stability of knee joint can be significantly reconstructed, and they are not statistically different in clinical effect. So both ways are reliable fixation ways in anterior cruciate ligament.