| 前外侧韧带重建与前外侧复合体修复治疗高度轴移的前交叉韧带合并前外侧韧带损伤的比较 |
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投稿时间：2024-07-13
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| 作者 | Author | 单位 | Address | E-Mail |
| 贾雪峰 |
JIA Xue-feng |
金华市人民医院, 浙江 金华 321000 |
Jinhua People's Hospital, Jinhua 321000, Zhejiang, China |
zjwywd@163.com |
| 吴青华 |
WU Qing-hua |
金华市人民医院, 浙江 金华 321000 |
Jinhua People's Hospital, Jinhua 321000, Zhejiang, China |
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| 邓同博 |
DENG Tong-bo |
金华市人民医院, 浙江 金华 321000 |
Jinhua People's Hospital, Jinhua 321000, Zhejiang, China |
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| 沈晓震 |
SHEN Xiao-zhen |
金华市人民医院, 浙江 金华 321000 |
Jinhua People's Hospital, Jinhua 321000, Zhejiang, China |
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| 叶剑平 |
YE Jian-ping |
金华市人民医院, 浙江 金华 321000 |
Jinhua People's Hospital, Jinhua 321000, Zhejiang, China |
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| 方贺 |
FANG He |
金华市人民医院, 浙江 金华 321000 |
Jinhua People's Hospital, Jinhua 321000, Zhejiang, China |
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| 周荣昌 |
ZHOU Rong-chang |
金华市人民医院, 浙江 金华 321000 |
Jinhua People's Hospital, Jinhua 321000, Zhejiang, China |
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| 曹扬 |
CAO Yang |
金华市人民医院, 浙江 金华 321000 |
Jinhua People's Hospital, Jinhua 321000, Zhejiang, China |
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| 陈有芬 |
CHEN You-fen |
金华市人民医院, 浙江 金华 321000 |
Jinhua People's Hospital, Jinhua 321000, Zhejiang, China |
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| 杨骐宁 |
YANG Qi-ning |
金华市中心医院, 浙江 金华 321000 |
Jinhua Central Hospital, Jinhua 321000, Zhejiang, China |
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| 徐国红 |
XU Guo-hong |
东阳市人民医院, 浙江 金华 322100 |
Dongyang People's Hospital, Jinhua 322100, Zhejiang, China |
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| 期刊信息：《中国骨伤》2024年，第37卷，第11期，第1101-1106页 |
| DOI：10.12200/j.issn.1003-0034.20231280 |
| 基金项目:金华市科技计划项目社发类重点(计划编号:2020-3-055) |
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中文摘要:
目的: 回顾性分析前外侧韧带重建术与前外侧复合体修复术对合并高度轴移的前交叉韧带损伤的临床疗效。
方法: 回顾性分析2018年1月至2022年6月存在高度轴移的前交叉韧带(anterior cruciate ligament,ACL)合并前外侧韧带(anterolateral ligament,ALL)损伤患者49例。其中29例接受ACL重建联合前外侧复合体修复为修复组,男23例,女6例;年龄20~37(27.5±4.8)岁;左侧13例,右侧16例;合并半月板损伤11例。20例接受ACL重建联合ALL重建术为重建组,男17例,女3例;年龄20~38(27.1±4.5)岁;左侧8例,右侧12例;合并半月板损伤6例。比较两组患者膝关节稳定性(轴移试验、KT 2000)、膝关节活动度、膝关节功能Lysholm评分、辛辛那提体育活动量表(Cincinnati sports activity scale,CSAS)评分及Tegner运动水平评分。
结果: 49例均获得随访,修复组随访13~20(15.3±1.8)个月,重建组12~21(16.0±2.2)个月。两组患者术前轴移试验分级分布差异无统计学意义(P>0.05);术后末次随访修复组中0级24例,1级5例;重建组中0级18例,1级2例,两组患者轴移试验分级分布差异无统计学意义(P>0.05)。两组术前KT 2000胫骨位移值分别为(9.39±0.77) mm(修复组)和(9.14±0.78) mm(重建组),差异无统计学意义(P>0.05)。术后末次随访修复组中KT 2000胫骨位移<3 mm有24例,3~5 mm有5例;重建组中<3 mm有18例,3~5 mm有2例;两组患者分布差异无统计学意义(P>0.05)。但重建组KT 2000胫骨位移(1.30±0.86) mm小于修复组的(1.99±1.11) mm(P<0.05)。两组术后末次随访健侧膝关节活动度比较差异无统计学意义(P>0.05),患侧修复组膝关节伸屈活动度范围要小于重建组(P<0.05)。两组术前膝关节Lysholm及CSAS评分差异无统计学意义(P>0.05),术后末次随访两组Lysholm及CSAS评分均相比术前有明显改善,而重建组Lysholm及CSAS评分要优于修复组(P<0.05);Tegner评分显示修复组16例恢复伤前活动水平,重建组17例恢复伤前水平,后者明显优于前者(P<0.05)。
结论: 相比前外侧复合体修复,ALL联合ACL重建治疗对合并高度轴移的ACL损伤患者能获得更好的膝关节功能和稳定性,这有利于减少ACL重建失败的风险。 |
| 【关键词】前外侧韧带 前交叉韧带重建 高度轴移 |
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| Comparison of anterior lateral ligament reconstruction and anterior lateral complex repair in the treatment of anterior cruciate ligament combined with anterior lateral ligament injury with high-grade pivot shift |
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ABSTRACT
Objective To retrospectively analyze the clinical efficacy of anterior cruciate ligament (ACL) reconstruction combined with anterolateral complex repair and ACL reconstruction combined with ALL reconstruction in the treatment of anterior cruciate ligament injuries with high-grade pivot shift.
Methods From January 2018 to June 2022,49 patients combined ACL and ALL injuries with high-grade pivot shift were retrospectively studied from three hospitals,29 of them underwent ACL reconstruction with anterolateral complex repair (repair group),including 23 males and 6 females with an average age of (27.5±4.8) years old,ranged from 20 to 37 years old;the injured sides were 13 on the left and 16 on the right,and 11 patients were suffered with meniscus injury. The other 20 patients underwent ACL and ALL reconstruction (reconstruction group) including 17 males and 3 females with the mean age of (27.1±4.5) years old,ranged from 20 to 38 years old;the injured sides were 8 on the left and 12 on the right,and 6 patients were suffered with meniscus injury. Knee stability (pivot shift test,KT-2000),range of motion,knee function (Lysholm scoring scale,Cincinnati sports activity scale (CSAS) scoring scale,and Tegner activity level score between two groups were compared.
Results A total of 49 patients were followed up,the repair group receiving 13 to 20(15.3±1.8) months and the reconstruction group receiving 12 to 21(16.0±2.2) months. There was no statistically significant difference in the preoperative pivot shift test grading distribution between two groups (P>0.05). At the last postoperative follow-up,there were 24 patients with grade 0 and 5 patients with grade 1 in the repair group,and there were 18 patients with grade 0 and 2 patients with grade 1 in the reconstruction group,there is no significant difference in the distribution of axial shift test grading between two groups(P>0.05). The preoperative KT-2000 tibial displacement of two groups were (9.39±0.77) mm (repair group) and (9.14±0.78) mm (reconstruction group) respectively,with no statistically significant difference (P>0.05). At the final postoperative follow-up,there were 24 patients with KT-2000 tibial displacement <3 mm and 5 patients with 3 to 5 mm in the repair group,while 18 patients with <3 mm and 2 patients with 3 to 5 mm in the reconstruction group,KT-2000 tibial displacement distribution of two groups was no significant difference (P>0.05),but the KT-2000 tibial displacement in the reconstruction group (1.30±0.86) mm was significantly smaller than that in the repair group (1.99±1.11) mm (P<0.05). The final postoperative follow-up range of motion of the contralateral side knee between two groups was no significant difference (P>0.05). The range of motion of the suffering knee in the repair group was less than that in the reconstruction group (P<0.05). There was no significant difference in preoperative Lysholm and CSAS scores between two groups (P>0.05). At the final postoperative follow-up,both groups showed significant improvement in Lysholm and CSAS scores,while the Lysholm and CSAS scores of the reconstruction group were better than those of the repair group,and the difference was statistically significant (P<0.05). Significant differences was found in Tegner scores between two groups,which 16 patients in the repair group returned to their pre-injury activity level,and 17 patients in the reconstruction group returned to their pre-injury level (P<0.05).
Conclusion Compared to anterolateral complex repair,combined ACL and ALL reconstruction in the treatment of ACL injuries with high-grade pivot shift results in better knee joint function and stability. This is advantageous in reducing the risk of ACL reconstruction failure. |
| KEY WORDS Anterior lateral ligament Anterior cruciate ligament reconstruction High-grade pivot shift |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 贾雪峰,吴青华,邓同博,沈晓震,叶剑平,方贺,周荣昌,曹扬,陈有芬,杨骐宁,徐国红.前外侧韧带重建与前外侧复合体修复治疗高度轴移的前交叉韧带合并前外侧韧带损伤的比较[J].中国骨伤,2024,37(11):1101~1106 |
| 英文格式: | JIA Xue-feng,WU Qing-hua,DENG Tong-bo,SHEN Xiao-zhen,YE Jian-ping,FANG He,ZHOU Rong-chang,CAO Yang,CHEN You-fen,YANG Qi-ning,XU Guo-hong.Comparison of anterior lateral ligament reconstruction and anterior lateral complex repair in the treatment of anterior cruciate ligament combined with anterior lateral ligament injury with high-grade pivot shift[J].zhongguo gu shang / China J Orthop Trauma ,2024,37(11):1101~1106 |
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