目的 通过关节镜下应用自体四股腘绳肌腱（semitendinosus/gracilis，ST/G）前交叉韧带(anterior cruciate ligament, ACL)重建术治疗ACL损伤，探讨采用不同手术方式和不同康复训练方式术后的疗效对比及其影响因素。 方法 回顾性分析自2017年1月至2018年3月期间本院收治的ACL损伤患者共80例（80膝），按照手术方式及康复训练方式不同分为4组，每组20例（20膝），包括保残专业康复组，保残常规康复组，非保残专业康复组，非保残常规康复组。比较末次随访时4组膝关节功能评分、稳定性试验和本体感觉测量结果。 结果 术后患者随访时间均为12个月。4组术后末次随访时Lysholm和IKDC评分均较术前明显增高（P<0.001），且四组间有显著性差异（P<0.001）。术后四组患侧与健侧位置觉差异对比均有统计学意义（P<0.001）。基于Lysholm、IKDC评分中末次随访与术前的差值增量、患侧与健侧位置觉差异为因变量，以手术方式和康复训练方式为自变量行双因素方差分析，两自变量对膝关节功能评分和本体感觉恢复影响具有显著性（P<0.001），并且保残组两评分增量显著高于非保残组（P<0.001），专业康复组两评分增量显著高于常规康复组（P<0.001），而保残组位置觉差异显著低于非保残组（P<0.001），专业康复组位置觉差异显著低于常规康复组（P<0.001）。 结论 关节镜下自体四股ST/G保留下止点残端重建术是治疗ACL损伤的理想手术方案，术后实施分时段、个体化专业运动疗法康复，能够促进膝关节功能和本体感觉恢复，有助于患者尽早康复和重返运动。
Abstract
Objective To investigate the effect of different surgical methods and different rehabilitation training methods in the treatment of ACL injury by arthroscopic anterior cruciate ligament (ACL) reconstruction with autologous hamstring tendon (ST/G). Methods From January 2017 to March 2018, 80 patients (80 knees) with ACL injury in our hospital were retrospectively analyzed. They were divided into four groups according to the operation and rehabilitation training methods, 20 cases in each group (20 knees), including a remnant-preserving professional rehabilitation group, a remnant-preserving routine rehabilitation group, a remnant-eliminating professional rehabilitation group and a remnant-eliminating routine rehabilitation group. The knee function score, stability test and proprioception measurement results of the four groups at the last follow-up were compared. Results All patients were followed up for 12 months. The Lysholm and IKDC scores of the four groups at the last follow-up were significantly higher than those before operation (P<0.001), and there were significant differences among the four groups (P<0.001). There were significant differences in position perception between the affected side and the healthy side in the four groups after operation (P<0.001). Based on Lysholm and IKDC scores, the increment of difference between the last follow-up and preoperative, the difference of position perception between the affected side and the healthy side were the dependent variables, and the operation mode and rehabilitation training mode were the independent variables for two-way ANOVA. The two independent variables had significant effects on knee function score and proprioception recovery (P<0.001). In addition, the increment of two scores in the remnant-preserving group was significantly higher than that in the remnant-eliminating group (P<0.001). The increment of two scores in the professional rehabilitation group was significantly higher than that in the routine rehabilitation group (P<0.001). The difference of position sense in the remnant-preserving group was significantly lower than that in the remnant-eliminating group (P<0.001), and the difference of position sense in the professional rehabilitation group was significantly lower than that in the routine rehabilitation group (P<0.001). Conclusions Arthroscopic reconstruction preserving the tibial remnant with four strand ST/G is an ideal surgical plan for the treatment of ACL injury. Postoperative rehabilitation of segmented and individualized professional kinesiotherapy can promote the recovery of knee function and proprioception, and can help patients recover and return to exercise as soon as possible.
关键词
关节镜； /
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前交叉韧带重建； /
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手术方式； /
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康复训练方式； /
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影响因素
Key words
Arthroscopy; /
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Anterior cruciate ligament reconstruction; /
Operation method /
Rehabilitation training mode; /
Influencing factors
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