关节镜下保留残端与非保残重建前交叉韧带的疗效比较
Comparison of retaining ligament stump and non-reserving stump on anterior cruciate ligament reconstruction by arthroscopy
目的 比较关节镜下保留及非保留残端重建前交叉韧带 (anterior cruciate ligament, ACL) 的疗效。 方法 选择我院2014.03~2015.05收治的64例有韧带残端残留的ACL断裂患者64例为研究对象，采用关节镜下四股自体腘绳肌腱单束重建技术，随机分为两组，即保留残端组和非保留残端组，每组32例，非保残组给予切除残端行常规关节镜手术重建ACL，保残组在保留残端的基础上行关节镜下ACL重建术。记录比较两组术前、术后关节稳定性及功能评分进行对比，术后1年测本体感觉，部分患者二次手术时探查重建韧带。 结果 64 例均获随访，随访时间 12~27个月。术后1年Lysholm评分，非保残组平均91.9分，保残平均93.2分；IKDC 评分功能在A、B级非保残组29例，保残组30例；抽屉试验阴性非保残组29例保残组31例，Lachman 试验阴性两组均为30例，比较差异均无统计学意义( P＞0.05)；两组的本体感觉重复试验无差异，患者自述关节稳定性及位置觉以观察组稍优，术后共有9例患者二次行关节镜手术，对照组4例，观察组5例，镜下见对照滑膜覆盖率及韧带表面光滑度较观察组稍差，因例数太少，未行统计学分析。 结论 关节镜下保留残端与非保留残端单束重建术重建 ACL ，均能获得满意的临床效果，但关节镜下保留残端患者有更好的自我感觉，可能和保留残端有利于移植物的再血管化及本体感受器的恢复有关，需要更多的数据来进行统计学分析。
Objective To compare the outcome of anterior cruciate ligament ( ACL) reconstruction under Arthroscopy with preserving versus removing the remnant of native ACL using hamstring autograft．Methods From March 2014 to May 2015, 64 patients underwent ACL reconstruction using hamstring autograft. They were randomly divided into two groups, with 32cases in each group. The control group removed residual ligament and the experimental group retained ligament stump Preoperative, postoperative joint stability, and functional scores were recorded and compared in the two groups. 1 year after the operation the proprioception was tested in all patients, and some patients underwent a second surgery to explore the reconstruction of the ligament. Result 64 cases were followed up with a length of 12~27 months. One year after the operation results were compared. The Lysholm score of the control group was 91.9 points, and that of experimental group was 93.2 points; IKDC score of the control group in grade A and B was 29 cases, and that of the experimental group was 30 cases; the drawer test negative in control group was 29 cases and in experimental group was 31 cases. Lachman test in the two group was both 30 cases, and there was no statistically significant difference (P>0.05).The proprioception repeated test of two group had no significant difference. The self-reported joint stability and position sense in the experimental group was better than that of the control group after operation. There were 9 patients underwent a second arthroscopic surgery, with 4 cases in the control group and 5 cases in the experimental group. Microscopically, synovial coverage and ligament surface smoothness of the observation group were better than in the control group. Because the number of cases is too small, no statistical analysis was performed. Conclusions Anterior cruciate ligament (ACL) reconstruction under Arthroscopy with preserving versus removing the remnant of native ACL could both result in satisfactory clinical outcomes. However，the proprioception of patients in the stump-preserving group was better than that in the non-preserving group possibly due to the revascularization and re-establishment of the proprioception facilitated by the stump preservation, which requires confirmation with more data.
前交叉韧带损伤 / 前交叉韧带重建 / 保留残端 / 关节镜检查
Anterior cruciate ligament injury / anterior cruciate ligament reconstruction / retained stump / arthroscopy
[1] 王守安, 张胜昌, 钟震亚, 等. 膝交叉韧带的血供及其临床意义[J]. 中国临床解剖学杂志, 2009, 27(5): 516-519.
[2] Veltri DM. Arthroscopic anterior cruciate ligament reconstruction[J]. Clin Sports Med, 1997, 16(1):123-144.
[3] Lee BI，Min KD，Choi HS，et al． Arthroscopic anterior cruciate ligament reconstruction with the tibial-remnant preserving technique using a hamstring graft[J]．Arthroscopy, 2006,22(3): 340-347.
[4] 谭平先，叶淦湖，侯之启，等. 关节镜下单束重建治疗前交叉韧带部分断裂的临床研究[J].中华关节外科杂志，2012，6(1):44-48.
[5] 张抒，张强，范长春，等. 保留残余束支及残端纤维重建前交叉韧带[J].中国矫形外科杂志，2010,18(8)：626-628.
[6] Dhillon MS, Bali K, Vasistha RK. Immunohistological evaluation of proprioceptive potential of the residual stump of injured anterior cruciate ligaments (ACL)[J]. Int Orthop, 2010, 34(5): 737-741.
[7] 许锦煌, 黄建荣, 尹萍, 等. 保留残端对前交叉韧带重建术后恢复的临床意义[J]. 中国临床解剖学杂志, 2015, 33(5): 584-587.
[8] 张磊, 郭晓光, 祁冀, 等. 食蟹猴单膝ACL损伤模型中ACL与腘绳肌本体感受器的变化[J]. 中国临床解剖学杂志, 2017, 35(3): 301-306.
[9] Nakase J, Toratani T, Kosaka M, et al. Roles of ACL remnants in knee stability[J]. Knee Surg Sports Traumatol Arthrosc, 2013, 21(9):2101-2106.
[10]Bali K, Dhillon MS, Vasistha RK, et al. Efficacy of immunohistological methods in detecting unctionally viable mechanoreceptors in the remnant stumps of injured anterior cruciate ligaments and its clinical importance[J].Knee Surg Sports Traumatol Arthrosc, 2012, 20(1):75-80.
[11]于长隆，曲绵域. 实用运动医学[M]. 北京：北京大学医学出版社, 2003:482-483.
[12]Gohil S, Annear PO, Breidahl W. Anterior cruciate ligament reconstruction using autologous double hamstrings: a comparison of standard versus minimal debridement techniques using MRI to assess revascularisation. A randomised prospective study with a one- year follow-up[J]. J Bone Joint Surg Br, 2007, 89(9):1165-1171.
[13]Lee BI, Kwon SW, Kim JB, et al. Comparison of clincal results according to amount of reserved remnant in arthroscopic anterior cruciate ligement recon struction using quadrupled hamstring graft. [J].Arthroscopy, 2008, 24 (5):560-568.
[14]刘雪峰，王鲲鹏，廉永云，等． 关节镜下保留前交叉韧带残端的前交叉韧带重建[J]．临床骨科杂志，2010，13( 2) : 143-144.
[15]廖志文. 关节镜下保留与不保留残端重建交叉韧带效果的Meta分析[J]. 微创医学，2015,10(1):19-21.
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