| 前交叉韧带重建术中界面螺钉在股骨侧的改良应用 |
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投稿时间：2023-03-02
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| 作者 | Author | 单位 | Address | E-Mail |
| 汪庚申 |
WANG Geng-shen |
武威市人民医院关节外科, 甘肃 武威 733000 |
Depatrment of Joint Surgery, Wuwei People's Hospital, Wuwei 733000, Gansu, China |
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| 牛存良 |
NIU Cun-liang |
武威市人民医院关节外科, 甘肃 武威 733000 |
Depatrment of Joint Surgery, Wuwei People's Hospital, Wuwei 733000, Gansu, China |
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| 赵海燕 |
ZHAO Hai-yan |
兰州大学第一附属医院关节外科, 甘肃 兰州 730000 |
Depatrment of Joint Surgery, the First Affiliated Hospital of Lanzhou University, Lanzhou 730000, Gansu, China |
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| 王世中 |
WANG Shi-zhong |
武威市人民医院关节外科, 甘肃 武威 733000 |
Depatrment of Joint Surgery, Wuwei People's Hospital, Wuwei 733000, Gansu, China |
413199705@qq.com |
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| 期刊信息：《中国骨伤》2023年，第36卷，第8期，第754-759页 |
| DOI：10.12200/j.issn.1003-0034.2023.08.011 |
| 基金项目:甘肃省武威市2022年度科技局民生科技计划项目(编号:WW2201MSS037) |
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中文摘要:
目的：比较股骨侧袢钢板固定和界面螺钉由股骨侧进钉固定前交叉韧带股骨端的临床疗效。
方法：回顾性分析2019年1至2021年9月行关节镜下前交叉韧带重建患者65例,按其股骨侧固定方式不同分为袢钢板组和界面钉组。袢钢板组(袢钢板固定)35例,男27例,女8例,年龄18~50(35.00±7.60)岁。界面钉组(界面钉固定)30例,男20例,女10例,年龄18~50(32.00±8.50)岁。比较两组患者住院时间、住院费用、手术时间、术中并发症,术后1、3、6 d的C反应蛋白及术后18个月Lysholm评分和国际膝关节文献委员会(International Knee Documentation Committee,IKDC)评分和CT测量的股骨隧道直径扩大值。
结果：所有患者成功接受手术,并获得随访,时间18~36(25.16±4.50)个月。所有患者前抽屉试验和Lachman试验均转为阴性。两组患者住院时间、住院费用、并发症比较,差异无统计学意义(P>0.05);袢钢板组手术时间(74.00±6.84) min与界面钉组(91.67±6.34) min比较,差异有统计学意义(P<0.05);术后1、3 d袢钢板组C反应蛋白分别为(40.00±10.10)、(20.00±8.23) mg·L-1,界面钉组分别为(60.00±8.93)、(30±8.66) mg·L-1,两组比较差异有统计学意义(P<0.05);术后6 d两组C反应蛋白比较,差异无统计学意义(P>0.05)。术后18个月,Lysholm评分、IKDC评分比较,差异无统计学意义(P>0.05)。袢钢板组CT冠状位和矢状位股骨隧道直径扩大值分别为(2.75±0.19) mm、(1.55±0.25) mm,界面钉组分别为(2.81±0.22) mm、(1.61±0.20) mm,两组比较差异有统计学意义(P<0.05)。
结论：采用界面螺钉由关节外向内中央挤压固定肌腱,虽然手术步骤较为繁琐、手术时间略长,早期术后炎症反应略重,但骨隧道扩大却明显小于袢钢板悬吊固定,同时术后无金属异物残留,且临床效果与袢钢板悬吊固定无差异,仍然不失为一种良好的选择。 |
| 【关键词】前交叉韧带重建 股骨侧固定 带鞘界面螺钉 袢钢板悬吊固定 |
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| Modified application of interface screw in femoral side during anterior cruciate ligament reconstruction |
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ABSTRACT
Objective To compare clinical effects of the improved interface screw fixation of femoral end of anterior cruciate ligament with classic femoral lateral loop plate fixation.
Methods A retrospective analysis of 65 patients who underwent arthroscopic anterior cruciate ligament reconstruction from January 2019 to September 2021 were performed. According to the different fixation methods of the femoral side,35 patients were divided into loop plate fixation(loop plate group),including 27 males and 8 females,aged from 18 to 50 years old with an average of (35.00±7.60) years old;30 patients in interface screw fixation(interface screw group),including 20 males and 10 females,aged from 18 to 50 years old with an average of (32.00±8.50) years old. Hospital stay,hospital expenses,operation time,complications,C-reactive protein at 1,3,6 days after operation,and postoperative Lysholm score and International Knee Documentation Committee(IKDC) score at 18 months were compared between two groups.
Results All patients were successfully operated,and obtained follow-up from 18 to 36 months with an average of (25.16±4.50) months. Anterior drawer test and Lachman test of all patients turned to negative. There were no statistical differences in hospital stay,hospital expenses and complications between two groups(P>0.05);operation time in loop plate group was (74.00±6.84) min,and (91.67±6.34) min in interface screw group,and had difference between two groups(P<0.05). C-reactive protein on the 1st and 3rd day after operation was (40.00±10.10),(20.00±8.23) mg·L-1 in loop plate group,and (60.00±8.93),(30.00±8.66) mg·L-1 in interface nail group,had statistical difference between two groups (P<0.05);while there was no difference in C-reactive protein on the 6th day after operation(P>0.05). At 18 months after operation,Lysholm and IKDC scores showed no significant difference between two groups (P>0.05). In loop plate group,medullary enlargement on coronal and sagittal views were (2.75±0.19) mm,(1.55±0.25) mm,and (2.81±0.22) mm,(1.61±0.20) mm in interface screw group,and had statistical difference between two groups(P<0.05).
Conclusion In the reconstruction of anterior cruciate ligament,the common interface screw on the femoral side is changed to the sheath interface screw,and intramedullary screw is changed to the compression and fixation of tendon from outside to inside of joint. Although the operation procedure is relatively complicated and operation time is slightly longer,it has advantages of no residual metal foreign body after operation,and clinical effect is no different from classical loop plate suspension fixation,which is still a good choice. |
| KEY WORDS Anterior cruciate ligament reconstruction Femoral lateral fixation Sheathed interface screw Suspension and fixation of loop steel plate |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 汪庚申,牛存良,赵海燕,王世中.前交叉韧带重建术中界面螺钉在股骨侧的改良应用[J].中国骨伤,2023,36(8):754~759 |
| 英文格式: | WANG Geng-shen,NIU Cun-liang,ZHAO Hai-yan,WANG Shi-zhong.Modified application of interface screw in femoral side during anterior cruciate ligament reconstruction[J].zhongguo gu shang / China J Orthop Trauma ,2023,36(8):754~759 |
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