| 关节腔内移植物长度测量在前交叉韧带全内重建的应用研究 |
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投稿时间：2023-10-19
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| 作者 | Author | 单位 | Address | E-Mail |
| 龚时国 |
GONG Shi-guo |
九江市第一人民医院骨科, 江西 九江 332000 |
Department of Orthopaedics, the First People's Hospital of Jiujiang City, Jiujiang 332000, Jiangxi, China |
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| 谢荣辉 |
XIE Rong-hui |
九江市第一人民医院骨科, 江西 九江 332000 |
Department of Orthopaedics, the First People's Hospital of Jiujiang City, Jiujiang 332000, Jiangxi, China |
xieronghui1987@sina.com |
| 汪建样 |
WANG Jian-yang |
九江市第一人民医院骨科, 江西 九江 332000 |
Department of Orthopaedics, the First People's Hospital of Jiujiang City, Jiujiang 332000, Jiangxi, China |
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| 刘牧子 |
LIU Mu-zi |
九江市第一人民医院骨科, 江西 九江 332000 |
Department of Orthopaedics, the First People's Hospital of Jiujiang City, Jiujiang 332000, Jiangxi, China |
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| 期刊信息：《中国骨伤》2024年，第37卷，第7期，第655-663页 |
| DOI：10.12200/j.issn.1003-0034.20230244 |
| 基金项目:江西省卫生健康委科技计划 (编号:202211853) |
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中文摘要:
目的：探讨关节镜下测量关节腔内移植物长度在前交叉韧带(anterior cruciate ligament,ACL)全内重建应用的临床疗效。
方法：回顾性分析 2020 年 1 月至 2022 年 1 月收治的 ACL 损伤患者 60 例的资料,其中男 37 例,女23 例,年龄 22~44 岁。按照手术方式的不同,分为传统手术组(常规组)和拉线测量组(测量组),每组各 30 例。常规组男 20 例,女 10 例,年龄(30.00±3.95)岁;身体质量指数(body mass index,BMI)为(22.58±1.41) kg·m-2;左侧 9 例,右侧21 例;受伤至手术时间(3.00±1.35) d。测量组男 17 例,女 13 例,年龄(32.00±4.29)岁;BMI 为(23.29±1.39) kg·m-2;左侧12 例,右侧 18 例;受伤至手术时间(3.00±1.27) d。记录患者术前及术后 6、12 个月的临床资料。从术后视觉模拟评分法(visual analogue scale,VAS)、膝关节损伤与骨关节炎评分 (knee injury and osteoarthritis outcome score,KOOS)、Lysholm评分、国际膝关节文献委员会(International Knee Documentation Committee,IKDC)膝关节评估表、膝关节稳定性(Lach-man 试验、前抽屉试验和轴移试验)、术后不同阶段 CT 测量骨隧道直径增宽程度和 MRI 评分系统等方面比较两种方法的临床疗效。
结果：术后 6 个月两组 VAS 比较差异无统计学意义(P>0.05),术后 12 个月测量组 VAS(2.23±1.01)分,低于常规组(3.30±1.02)分(P<0.001)。术后 12 个月,两组 KOOS 评分除症状评分差异无统计学意义(P=0.221),其余各项评分差异均有统计学意义(P<0.05)。术后 6 个月,测量组 Lysholm 总分和 IKDC 总分均高于常规组(P<0.05)。术后 12个月,测量组 Lachman 试验、前抽屉试验和轴移试验和常规组比较,差异均无统计学意义(P>0.05);但是,整体膝关节不稳定性分析,测量组膝关节稳定性优于对照组(P=0.038)。术后 2 d 及术后 6、12 个月两组患者影像学评估结果显示, 测量组股骨和胫骨的肌腱隧道直径增宽程度均较常规组术后减少 (P<0.05);MRI 评分测量组患者均高于常规组(P<0.05)。
结论：关节镜下测量关节腔内移植物长度在全内技术 ACL 重建,肌腱利用率高,稳定性好,1 年内膝关节功能恢复满意,疗效肯定。 |
| 【关键词】关节镜 前交叉韧带重建 拉线法 关节内移植物长度 |
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| Application of intra-articular graft length measurement in total anterior cruciate ligament reconstruction |
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ABSTRACT
Objective To investigate the clinical efficacy of arthroscopic measurement of intra-articular graft length in the application of total internal reconstruction of the anterior cruciate ligament (ACL).
Methods The 60 patients with ACL injury treated between January 2020 and January 2022 were retrospectively analyzed. There were 37 males and 23 females,aged from 22 to 44 years. According to the different surgical methods,they were divided into two groups:conventional surgery group (conventional group) and pull line measurement group (measurement group),with 30 cases in each group. In the conventional group,there were 20 males and 10 females,with an average age of (30.00±3.95) years old;the body mass index (BMI) was (22.58±1.41) kg·m-2;there were 9 cases on the left side and 21 cases on the right side;the time from injury to operation was (3. 00±1.35) days. In the measurement group,there were 17 males and 13 females,with an average of (32.00±4.29) years; BMI was (23.29±1.39) kg·m-2;there were 12 cases on the left side and 18 cases on the right side;the time from injury to operation was (3.00±1.27) days. The clinical data of the patients before surgery,6 months after surgery and 12 months after surgery were collected and recorded. The clinical efficacy of the two methods was compared in terms of postoperative VAS,KOOS, Lysholm score,IKDC score,knee stability (Lachman test,anterior drawer test and axial shift test),the degree of widening of bone tunnel diameter measured by CT at different stages of the postoperative period and MRI scoring system.
Results At 12 months after surgery,the VAS of the measurement group was lower than that of the conventional group (P<0.001). At 12 months after surgery,KOOS scores in the measurement group were higher than those in the conventional group,and there were statistically significant differences in all scores except symptom scores (P<0.05). Six months after operation,Lysholm total score and IKDC total score in the measurement group were higher than those in the conventional group,and the difference was statistically significant (P<0.05). At 12 months after surgery,knee stability tests were performed,and the differences between the Lachman test, anterior drawer test and axial shift test measurement group and the conventional group were not statistically significant (P>0.05). However,overall knee instability analysis showed that the knee stability of the measurement group was better than that of the control group,and the difference between the groups was statistically significant (P=0.038). The imaging assessment of patients in both groups at 6 months after surgery showed that the widening of tendon tunnel diameter in both femur and tibia was reduced in the measurement group compared with the conventional group after surgery,and the difference was statistically significant (P<0.05);MRI scores were higher in all patients in the measurement group those in the conventional group,at 6 months and 12 months agter surgery (P<0.05).
Conclusion Arthroscopic measurement of intra-articular cavity graft length in total internal technique for ACL reconstruction,high tendon utilization,good stability,the knee joint function has recovered satisfactorily within one year,and the therapeutic effect is affirmed. |
| KEY WORDS Arthroscopy Anterior cruciae ligament reconstruction Wire pulling method Intra-articular graft length |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 龚时国,谢荣辉,汪建样,刘牧子.关节腔内移植物长度测量在前交叉韧带全内重建的应用研究[J].中国骨伤,2024,37(7):655~663 |
| 英文格式: | GONG Shi-guo,XIE Rong-hui,WANG Jian-yang,LIU Mu-zi.Application of intra-articular graft length measurement in total anterior cruciate ligament reconstruction[J].zhongguo gu shang / China J Orthop Trauma ,2024,37(7):655~663 |
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