吴关; 张辉; 李旭; 宋关阳; 洪雷

doi:10.3760/cma.j.cn121113-20220216-00068

点赞 0
分享 0
收藏 0
纠错

• 关节外科 •

前外侧韧带重建术治疗轴移试验Ⅱ级的前十字韧带损伤

中华骨科杂志, 2022,42(9) : 555-562. DOI: 10.3760/cma.j.cn121113-20220216-00068

摘要

目的

探讨膝关节前外侧韧带（anterolateral ligament，ALL）重建对轴移试验Ⅱ级的前十字韧带（anterior cruciate ligament，ACL）损伤重建术的作用。

方法

2015年10月至2018年8月，由同一医生收治的轴移试验Ⅱ级的ACL损伤患者59例，采用ACL+ALL重建或单纯ACL重建治疗。ACL+ALL重建组29例，男20例、女9例，年龄（30.5±8.3）岁（范围15~48岁）；左膝11例，右膝18例；受伤至手术时间为5（2，9）个月（范围3 d~240个月）；合并内侧半月板损伤15例、外侧半月板损伤8例。单纯ACL重建组30例，男24例、女6例，年龄（32.2±9.7）岁（范围17~51岁）；左膝14例，右膝16例；受伤至手术时间为7（2，11）个月（范围10 d~240个月）；合并内侧半月板损伤18例、外侧半月板损伤11例。术后随访1年，应用Lachman试验、轴移试验和KT-1000侧-侧差值评估膝关节稳定性，国际膝关节评分委员会（International Knee Documentation Committee，IKDC）主观评估表和Lysholm评分评估膝关节功能。轴移试验的结果分为0级、Ⅰ级、Ⅱ级、Ⅲ级，Lachman试验的结果分为阴性、1度松弛、2度松弛、3度松弛。

结果

所有患者均完成术后1年随访。术后1年时ACL+ALL重建组Lachman试验阴性25例、1度松弛4例，单纯ACL重建组阴性24例、1度松弛6例（Z=-0.91，P=0.361）；两组阳性率分别为13.8%和20.0%，差异无统计学意义（χ²=1.37，P=0.242）。ACL+ALL重建组术后KT-1000侧-侧差值为（1.9±1.3）mm，单纯ACL重建组为（2.2±1.3）mm，组间差异无统计学意义（t=0.66，P=0.513）。ACL+ALL重建组轴移试验0级27例、Ⅰ级2例，单纯ACL重建组0级20例、Ⅰ级8例、Ⅱ级2例（Z=-0.66，P=0.507）；ACL+ALL重建组轴移试验阳性率为6.5%，小于单纯ACL重建组的33.3%（χ²=21.70，P<0.001）。ACL+ALL重建组IKDC主观功能评分为（92.4±5.6）分，单纯ACL重建组为（90.2±6.7）分，组间差异无统计学意义（t=1.37，P=0.176）；ACL+ALL重建组Lysholm评分为（91.0±6.2）分，单纯ACL重建组为（89.1±5.0）分，组间差异无统计学意义（t=1.29，P=0.201）。

结论

对轴移试验Ⅱ级的ACL损伤患者采用ACL重建联合ALL重建手术较单纯行ACL重建术可改善术后膝关节旋转稳定性，但对膝关节前向稳定性及膝关节功能恢复无作用。

引用本文: 吴关, 张辉, 李旭, 等. 前外侧韧带重建术治疗轴移试验Ⅱ级的前十字韧带损伤 [J] . 中华骨科杂志, 2022, 42(9) : 555-562. DOI: 10.3760/cma.j.cn121113-20220216-00068.

参考文献导出: Endnote NoteExpress RefWorks NoteFirst 医学文献王

扫描看全文

正文

作者信息

基金 0 关键词 0

English Abstract

阅读 0 评论 0

相关资源

引用 | 论文 | 视频

版权归中华医学会所有。

未经授权，不得转载、摘编本刊文章，不得使用本刊的版式设计。

除非特别声明，本刊刊出的所有文章不代表中华医学会和本刊编委会的观点。

膝关节前十字韧带（anterior cruciate ligament，ACL）损伤是常见的下肢损伤，关节镜下ACL重建术是ACL损伤治疗的金标准。与保守治疗相比，重建手术可以改善运动功能和减轻关节症状^[1]，90%的ACL损伤患者在重建术后可获得满意的临床功能^[2]。然而，年轻及高运动水平患者行单纯ACL重建术后有较高的失效率以及残留膝关节旋转不稳定，对这部分患者单纯采用ACL重建的可靠性还存在争议^[3,4]。

贡献者信息

吴关

北京积水潭医院运动医学科，北京　100035

张辉

北京积水潭医院运动医学科，北京　100035

李旭

北京积水潭医院运动医学科，北京　100035

宋关阳

北京积水潭医院运动医学科，北京　100035

洪雷

北京积水潭医院运动医学科，北京　100035

通信作者

洪雷

北京积水潭医院运动医学科，北京　100035

Email：kneesurgery@sina.com

关键词

侧副韧带; 前交叉韧带重建; 关节不稳定性;

作者声明

【证据等级】

治疗性研究Ⅲ级

作者贡献声明

洪雷、张辉：研究指导、手术操作；吴关：论文撰写、手术操作；李旭、宋关阳：病例资料收集、统计分析

利益冲突

所有作者声明无利益冲突

历史

出版日期：2022-05-01

收稿日期：2022-02-16

本文编辑

马英

Joint Surgery

Anterolateral ligament reconstruction in treating anterior cruciate ligament injury with grade 2 pivot-shift

Wu Guan, Zhang Hui, Li Xu, Song Guanyang, Hong Lei

Published 2022-05-01

Cite as Chin J Orthop, 2022, 42(9): 555-562. DOI: 10.3760/cma.j.cn121113-20220216-00068

Abstract

Objective

To evaluate the clinical outcomes in anterior cruciate ligament (ACL) patients undergoing ACL reconstruction combined with anterolateral ligament (ALL) reconstruction in treating patients with Grade 2 pivot-shift.

Methods

From October 2015 to August 2018, a total of 59 patients with Grade 2 pivot shift were allocated into ALL reconstruction group underwent combined ACL and ALL reconstruction (n=29) and control group underwent isolated ACL reconstruction (n=30). Lachman, pivot-shift and KT-1000 side-to-side difference test were used to determine the knee laxity. International Knee Documentation Committee (IKDC) subjective score and Lysholm score were used to assess the knee function. The results of Lachman test and pivot-shift test were classified into -, 1+, 2+, 3+.

Results

All patients were followed up for 1 year. The average age was 30.5±8.3 years (range, 15-48 years) in ALL reconstruction group with 5 months duration from injury. The left knee was involved in 11 cases, while 18 cases in right knee in ALL reconstruction group. There were 15 cases with injury in medial meniscus and 8 cases in lateral meniscus. In control group, the average age was 32.2±9.7 years (range 17-51 years) with 14 cases in left knees and 16 in right knees. In these patients, 18 of them had medial meniscus injury, while other 11 patients had lateral meniscus injury. The average duration from injury to surgery was 7 months. The Lachman test (-: 25, 1+: 4 vs. -: 25, 1+: 4, Z=-0.91, P=0.361), KT-1000 arthrometer (1.9±1.3 mm vs. 2.2±1.3 mm, t=0.66, P=0.513), IKDC subjective score (92.4±5.6 vs. 90.2±6.7, t=1.37, P=0.176) and Lysholm score (91.0±6.2 vs. 89.1±5.0, t=1.29, P=0.201) did not show significant difference between the two groups. Pivot-shift test (-:27, 1+: 2 vs. -: 20, 1+: 8, 2+: 2, Z=-0.66, P=0.507). Pivot-shift test was significantly superior in ALL reconstruction group compared with that in control group (6.5% vs.33.3%, χ²=21.70, P<0.001).

Conclusion

Patients with preoperative Grade 2 pivot shift had significant improvement in rotatory knee laxity after ACL reconstruction combined with ALL reconstruction compared with isolated ACL reconstruction. However, there was no significant difference in anterior laxity and knee function scores between the two groups.

Key words:

Collateral ligaments; Anterior cruciate ligament reconstruction; Joint instability

Contributor Information

Wu Guan