中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2015年
1期
48-54
,共7页
邱远欢%周云%吕浩%荆珏华
邱遠歡%週雲%呂浩%荊玨華
구원환%주운%려호%형각화
前交叉韧带重建%膝关节%关节镜检查
前交扠韌帶重建%膝關節%關節鏡檢查
전교차인대중건%슬관절%관절경검사
Anterior cruciate ligament reconstruction%Knee joint%Arthroscopy
目的 比较关节镜下行前十字韧带(anterior cruciate ligament,ACL)单束重建过程中采用前内侧入口与辅助前内侧入口创建股骨隧道的初期临床疗效.方法 回顾性分析2012年3月至2014年2月采用自体半腱肌肌腱、股薄肌肌腱行ACL单束重建治疗单纯ACL完全断裂并获得完整随访的患者资料.根据创建股骨隧道时采用的入口方式,将患者分为前内侧入口组[14例,男8例,女6例;年龄19～ 60岁,平均(35.14±11.85)岁;受伤至手术时间(14.57±15.83)d;合并半月板损伤Stoller分级:0度1例,Ⅰ度3例,Ⅱ度10例]与辅助前内侧入口组[23例,男10例,女13例;年龄18 ～ 62岁,平均(39.78±12.72)岁;受伤至手术时间(14.70±15.25)d;合并半月板损伤Stoller分级:0度2例,Ⅰ度5例,Ⅱ度16例].末次随访时采用Lysholm、Tegner和IKDC评分系统评价膝关节功能,并通过Lachman试验及Pivot-shift试验评价膝关节前后及旋转稳定性.结果 两组患者均全部获得随访,前内侧入口组平均随访(16.07±7.31)个月,辅助前内侧入口组平均随访(13.35±5.92)个月.末次随访时,Lysholm、Tegner、IKDC评分:前内侧入口组分别为(89.86±7.90)分、(8.64±1.65)分、(89.31±8.16)分,辅助前内侧入口组分别为(92.17±6.72)分、(8.91±1.16)分、(90.89±7.80)分.Lachman试验:前内侧入口组11例阴性,3例阳性,阴性率为78.6％(11/14);辅助前内侧入口组20例阴性,3例阳性,阴性率为87.0％(20/23).Pivot-shift试验:前内侧入口组9例阴性,5例阳性,阴性率为64.3％ (9/14);辅助前内侧入口组20例阴性,3例阳性,阴性率为87.0％(20/23).两组患者术后末次随访Lysholm、Tegner、IKDC评分以及Lachman试验、Pivot-shift试验阴性率比较,差异均无统计学意义.结论 关节镜下行膝关节ACL单束重建时,应用前内侧入口与辅助前内侧入口创建股骨隧道,术后均可取得优良的初期临床疗效.
目的 比較關節鏡下行前十字韌帶(anterior cruciate ligament,ACL)單束重建過程中採用前內側入口與輔助前內側入口創建股骨隧道的初期臨床療效.方法 迴顧性分析2012年3月至2014年2月採用自體半腱肌肌腱、股薄肌肌腱行ACL單束重建治療單純ACL完全斷裂併穫得完整隨訪的患者資料.根據創建股骨隧道時採用的入口方式,將患者分為前內側入口組[14例,男8例,女6例;年齡19～ 60歲,平均(35.14±11.85)歲;受傷至手術時間(14.57±15.83)d;閤併半月闆損傷Stoller分級:0度1例,Ⅰ度3例,Ⅱ度10例]與輔助前內側入口組[23例,男10例,女13例;年齡18 ～ 62歲,平均(39.78±12.72)歲;受傷至手術時間(14.70±15.25)d;閤併半月闆損傷Stoller分級:0度2例,Ⅰ度5例,Ⅱ度16例].末次隨訪時採用Lysholm、Tegner和IKDC評分繫統評價膝關節功能,併通過Lachman試驗及Pivot-shift試驗評價膝關節前後及鏇轉穩定性.結果 兩組患者均全部穫得隨訪,前內側入口組平均隨訪(16.07±7.31)箇月,輔助前內側入口組平均隨訪(13.35±5.92)箇月.末次隨訪時,Lysholm、Tegner、IKDC評分:前內側入口組分彆為(89.86±7.90)分、(8.64±1.65)分、(89.31±8.16)分,輔助前內側入口組分彆為(92.17±6.72)分、(8.91±1.16)分、(90.89±7.80)分.Lachman試驗:前內側入口組11例陰性,3例暘性,陰性率為78.6％(11/14);輔助前內側入口組20例陰性,3例暘性,陰性率為87.0％(20/23).Pivot-shift試驗:前內側入口組9例陰性,5例暘性,陰性率為64.3％ (9/14);輔助前內側入口組20例陰性,3例暘性,陰性率為87.0％(20/23).兩組患者術後末次隨訪Lysholm、Tegner、IKDC評分以及Lachman試驗、Pivot-shift試驗陰性率比較,差異均無統計學意義.結論 關節鏡下行膝關節ACL單束重建時,應用前內側入口與輔助前內側入口創建股骨隧道,術後均可取得優良的初期臨床療效.
목적 비교관절경하행전십자인대(anterior cruciate ligament,ACL)단속중건과정중채용전내측입구여보조전내측입구창건고골수도적초기림상료효.방법 회고성분석2012년3월지2014년2월채용자체반건기기건、고박기기건행ACL단속중건치료단순ACL완전단렬병획득완정수방적환자자료.근거창건고골수도시채용적입구방식,장환자분위전내측입구조[14례,남8례,녀6례;년령19～ 60세,평균(35.14±11.85)세;수상지수술시간(14.57±15.83)d;합병반월판손상Stoller분급:0도1례,Ⅰ도3례,Ⅱ도10례]여보조전내측입구조[23례,남10례,녀13례;년령18 ～ 62세,평균(39.78±12.72)세;수상지수술시간(14.70±15.25)d;합병반월판손상Stoller분급:0도2례,Ⅰ도5례,Ⅱ도16례].말차수방시채용Lysholm、Tegner화IKDC평분계통평개슬관절공능,병통과Lachman시험급Pivot-shift시험평개슬관절전후급선전은정성.결과 량조환자균전부획득수방,전내측입구조평균수방(16.07±7.31)개월,보조전내측입구조평균수방(13.35±5.92)개월.말차수방시,Lysholm、Tegner、IKDC평분:전내측입구조분별위(89.86±7.90)분、(8.64±1.65)분、(89.31±8.16)분,보조전내측입구조분별위(92.17±6.72)분、(8.91±1.16)분、(90.89±7.80)분.Lachman시험:전내측입구조11례음성,3례양성,음성솔위78.6％(11/14);보조전내측입구조20례음성,3례양성,음성솔위87.0％(20/23).Pivot-shift시험:전내측입구조9례음성,5례양성,음성솔위64.3％ (9/14);보조전내측입구조20례음성,3례양성,음성솔위87.0％(20/23).량조환자술후말차수방Lysholm、Tegner、IKDC평분이급Lachman시험、Pivot-shift시험음성솔비교,차이균무통계학의의.결론 관절경하행슬관절ACL단속중건시,응용전내측입구여보조전내측입구창건고골수도,술후균가취득우량적초기림상료효.
Objective To compare the primary clinical results of the anteromedial portal (AMP) and accessory anteromedial portal (AAMP) techniques for femoral tunnel drilling in single-bundle anterior cruciate ligament (ACL) reconstruction.Methods Data of isolated ACL rupture patients who had undergone single-bundle ACL reconstruction with autologous semitendinosus and gracilis tendons from March of 2012 to February of 2014 were retrospectively analyzed.The femoral tunnels were drilled with AMP techniques in 14 patients (group AMP) and with AAMP techniques in 23 patients (group AAMP).All the patients were followed up for 6 to 29 months.At the latest follow-up the Lysholm,Tegner and international knee documentation committee (IKDC) scores were used to estimate knee joint function,while the Lachman test and Pivot-shift test were used to estimate knee joint instability.Results The average follow-up time was 16.07±7.31 months in group AMP and 13.35±5.92 months in group AAMP.In group AMP,the Lysholm,Tegner and IKDC average scores were 89.86±7.90,8.64±1.65 and 89.31±8.16,respectively.While they were 92.17±6.72,8.91±1.16 and 90.89±7.80 in group AAMP,respectively.In group AMP the Lachman test was negative in 11 patients and positive in 3 patients.In group AAMP the Lachman test was negative in 20 patients and positive in 3 patients.The Pivotshift test was negative in 9 patients,positive in 5 patients and negative in 20 patients,positive in 3 patients in group AMP and AAMP,respectively.There were no significant differences in Lysholm,Tegner,IKDC scores,the negative rates of Lachman and Pivot-shift tests between two groups.Conclusion Single-bundle ACL reconstructions using AMP and AAMP techniques for femoral tunnel drilling have similar excellent primary clinical results.
