保留残端对前交叉韧带重建术后恢复的临床意义

doi:10.13418/j.issn.1001-165x.2015.05.022

中国临床解剖学杂志 ›› 2015, Vol. 33 ›› Issue (5): 584-587.doi: 10.13418/j.issn.1001-165x.2015.05.022

保留残端对前交叉韧带重建术后恢复的临床意义

许锦煌¹,　黄建荣^1，2,　尹萍¹,　郑沛中¹,　张玮琼¹,　叶培²,　欧阳振华¹黄生辉², 　刘贵旺²

1.增城市人民医院（中山大学附属博济医院）创伤骨科，广州 511300；
2.中山大学孙逸仙纪念医院创伤骨科，广州 510120

收稿日期:2014-12-07 出版日期:2015-09-25 发布日期:2015-10-13
通讯作者: 黄建荣，副教授，硕士生导师，E-mail：guke16@163.com
作者简介:许锦煌 (1983-)，男，福建泉州人，住院医师，在职研究生，主要研究方向：关节疾病，E-mail:xujinhuang23@163.com
基金资助:
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）

The clinical significance of residual preservation in the operation of anterior cruciate ligament reconstruction and its postoperative recovery

XU Jin-huang¹, HUANG Jian-rong ^1,2, YIN Ping¹, ZHENG Pei-zhong ¹, ZHANG Wei-qiong¹, YE Pei², OUYANG Zhen-hua ¹, HUANG Sheng-hui ², LIU Gui-wang ²

1.Department of Traumatic Orthopedics, Zengcheng People’s Hospital, Guangzhou 511300; 2.Department of Orthopedics, Sun Yet-sen Memorial Hospital, Sun Yet-sen University, Guangzhou 510120, China

Received:2014-12-07 Online:2015-09-25 Published:2015-10-13

摘要/Abstract

摘要：

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。

关键词: 膝关节, 保留残端, 前交叉韧带, 重建术

Abstract:

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.

Key words: Knee, Residual preservation, Anterior cruciate ligament, Reconstruction

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. 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.

参考文献

[1] Shelbourne KD, Nitz P. Accelerated rehabilitation after anterior cruciate ligament reconstruction[J]. Am J Sports Med, 1990, 18(3):292-299.
[2] Veltri DM. Arthroscopic anterior cruciate ligament reconstruction[J]. Clin Sports Med, 1997, 16(1):123-144.
[3] Piefer JW, Pflugner TR, Hwang MD, et al. Anterior cruciate ligament femoral footprint anatomy: systematic review of the 21st century literature[J]. Arthroscopy, 2012, 28(6):872-881.
[4] 孔颖，张元民，赵晓伟. 关节镜下保留残端四股腘绳肌腱单束重建后交叉韧带疗效观察[J]. 中国修复重建外科杂志, 2013, 27(09):1037-1040.
[5] Unterhauser FN, Bail HJ, Hoher J, et al. Endoligamentous revascularization of an anterior cruciate ligament graft[J]. Clin Orthop Relat Res, 2003(414):276-288.
[6] 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.
[7] Tsuda E, Okamura Y, Otsuka H, et al. Direct evidence of the anterior cruciate ligament-hamstring reflex arc in humans[J]. Am J Sports Med,2001, 29(1):83-87.
[8] Ochi M, Iwasa J, Uchio Y, et al. Induction of somatosensory evoked potentials by mechanical stimulation in reconstructed anterior cruciate ligaments[J]. J Bone Joint Surg Br, 2002, 84(5):761-766.
[9] Georgoulis AD, Pappa L, Moebius U, et al. The presence of proprioceptive mechanoreceptors in the remnants of the ruptured ACL as a possible source of re-innervation of the ACL autograft[J]. Knee Surg Sports Traumatol Arthrosc, 2001, 9(6):364-368.
[10] Fu FH, Shen W, Starman JS, et al. Primary anatomic double-bundle anterior cruciate ligament reconstruction: a preliminary 2-year prospective study[J]. Am J Sports Med, 2008, 36(7):1263-1274.
[11] Lee MC, Seong SC, Lee S, et al. Vertical femoral tunnel placement results in rotational knee laxity after anterior cruciate ligament reconstruction[J]. Arthroscopy, 2007, 23(7):771-778.
[12] Hollis R, West H, Greis P, et al. Autologous bone effects on femoral tunnel widening in hamstring anterior cruciate ligament reconstruction[J]. J Knee Surg, 2009, 22(2):114-119.
[13] Junkin DJ, Johnson DL. ACL tibial remnant, to save or not[J]？Orthopedics, 2008, 31(2):154-159.
[14] Lee BI, Kwon SW, Kim JB, et al. Comparison of clinical results according to amount of preserved remnant in arthroscopic anterior cruciate ligament reconstruction using quadrupled hamstring graft[J]. Arthroscopy, 2008, 24(5):560-568.
[15] Adachi N, Ochi M, Uchio Y, et al. Anterior cruciate ligament augmentation under arthroscopy. A minimum 2-year follow-up in 40 patients[J]. Arch Orthop Trauma Surg, 2000, 120(3-4):128-133.
[16] Colombet P, Robinson J, Jambou S, et al. Two-bundle, four-tunnel anterior cruciate ligament reconstruction[J]. Knee Surg Sports Traumatol Arthrosc, 2006, 14(7):629-636.
[17] Yagi M, Wong E K, Kanamori A, et al. Biomechanical analysis of an anatomic anterior cruciate ligament reconstruction[J]. Am J Sports Med, 2002, 30(5):660-666.
[18] Muneta T, Koga H, Mochizuki T, et al. A prospective randomized study of 4-strand semitendinosus tendon anterior cruciate ligament reconstruction comparing single-bundle and double-bundle techniques[J]. Arthroscopy, 2007,23(6):618-628.
[19] Ferretti A, Monaco E, Labianca L, et al. Double bundle or single bundle plus extra-articular tenodesis in ACL reconstruction? A CAOS study[J]. Knee Surg Sports Traumatol Arthrosc, 2008, 16(1):98.
[20] 陆伟，王大平，肖德明. 前交叉韧带重建股骨足迹精确定位的解剖与临床研究[J]. 中国临床解剖学杂志, 2011, 29(05):513-516.
[21] Wang J, Ao Y. Analysis of different kinds of cyclops lesions with or without extension loss[J]. Arthroscopy, 2009, 25(6):626-631.

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

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