保留残端对前交叉韧带重建术后恢复的临床意义
许锦煌,黄建荣,尹萍,郑沛中,张玮琼,叶培,欧阳振华,黄生辉,刘贵旺
中国临床解剖学杂志 ›› 2015, Vol. 33 ›› Issue (5) : 584-587.
保留残端对前交叉韧带重建术后恢复的临床意义
The clinical significance of residual preservation in the operation of anterior cruciate ligament reconstruction and its postoperative recovery
目的 对78例患者保留前交叉韧带残端的膝关节前交叉韧带重建术后膝关节功能及稳定性的评价，探讨保留前交叉韧带残端对患者术后韧带功能恢复中的临床作用。 方法 2009年1月～2013年1月，取保留前交叉韧带残端的膝关节前交叉韧带重建术患者78例，其中男性51例，女性27例，平均年龄29.2岁，受伤至手术平均时间为3个月，随访时间均大于12个月，全部病例均采用同种异体腘绳肌腱重建前交叉韧带。78例患者均存在前交叉韧带完全断裂，包括30例体部断裂，44例股骨起点断裂，ACL胫骨止点断裂4例，尽量保留残端。术后对患者膝关节的稳定性及膝关节功能进行随访，通过相关检查来判断临床效果。 结果 取末次随访数据进行分析，末次随访时间12～35个月，平均25个月。有76例患者前抽屉试验、Lachman试验、轴移试验均为阴性；对比术前，膝关节前后稳定性、Lysholm评分、Tegner评分及IKDC综合评分均有所改善，差异具有统计学意义（P<0.05）。 结论 保留残端对ACL重建术有良好的临床疗效。
Objective According to the analysis of the knee function and the stability, the postoperative efficacy of the anterior cruciate ligament(ACL) reconstruction with residual preservation was evaluated and the clinic role of residual preservation was explored. Methods From January 2011 to January 2013,78 cases of patients diagnosed with the anterior cruciate ligament rupture underwent ACL reconstruction with allogeneic hamstring tendons, and all patients were followed up for at least 12 months. Of the 78 cases , there were 51 males and 27 females with an average age of 29.2 years old. The average interval from injury tosurgery was 3 months; All 78 cases of patients had complete rupture of the anterior cruciate ligament, including 30 cases of body rupture, 44 cases of femoral attachment point rupture and 4 cases of tibial attachment point rupture. Surgery was performed in a way that could retain the remaining stump as much as possible. The postoperative knee function and stability were followed up for a period of 12~35 months with an average of 25 months. The clinic effects were evaluated according to the physical examination. Results Lachmantest, anterior drawer test and pivot shift test were negative in 76 patients. Compared to preoperative data, postoperative Lysholmscores, Tegnerscores and IKDC scores were significantly improved（P<0.05）. Conclusion Reserved stump had important significance in ACL reconstruction operation. ACL reconstruction operation with it could achieve a good clinical efficacy.
Knee / Residual preservation / Anterior cruciate ligament / Reconstruction
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广东省科技基金（2010B031600184）；广州市科技和信息化局重点项目基金（11C31120789）；广东省自然科学基金（S2012010010629，S2013010013768）
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