摘要
目的探讨手术时机对关节镜下前交叉韧带重建手术临床效果的影响。方法回顾性分析北部战区空军医院自2017年9月至2020年1月收治的接受关节镜下前交叉韧带重建手术的88例(88膝)患者的临床资料。根据受伤至手术时间,将患者分为两组,A组(n=41)在受伤后3周内接受重建手术,B组(n=47)在受伤后超过6周接受重建手术。比较两组患者术前和末次随访时的Lysholm评分、国际膝关节评分委员会(IKDC)评分、膝关节最大屈曲角度,以及前抽屉试验阳性、Lachman试验阳性比例;同时,在术中观察两组患者的合并症情况。结果所有患者手术顺利,无麻醉意外及死亡患者,术后未出现血管神经损伤及膝关节感染等并发症。术后随访时间9~12个月,平均10个月,所有患者随访期间膝关节无二次手术。A组和B组末次随访时的Lysholm评分、IKDC评分、膝关节最大屈曲角度均大于术前,且A组末次随访时的Lysholm评分、IKDC评分大于B组,差异有统计学意义(P<0.05)。A组合并半月板损伤内侧7例(17.1%)、外侧11例(26.8%)、双侧9例(22.0%),B组合并半月板损伤内侧8例(17.0%)、外侧4例(8.5%)、双侧19例(40.0%),两组合并半月板损伤比例比较,差异有统计学意义(P<0.05)。A组合并关节软骨损伤Ⅰ级8例(19.5%)、Ⅱ级7例(17.1%)、Ⅲ级4例(9.8%)、Ⅳ级1例(2.4%),B组合并关节软骨损伤Ⅰ级3例(6.4%)、Ⅱ级7例(14.9%)、Ⅲ级9例(19.1%)、Ⅳ级10例(21.3%),两组合并关节软骨损伤比例比较,差异有统计学意义(P<0.05)。两组患者术前和末次随访时的前抽屉试验阳性、Lachman试验阳性比例比较,差异均无统计学意义(P>0.05)。两组患者末次随访时的前抽屉试验阳性、Lachman试验阳性比例均低于术前,差异有统计学意义(P<0.05)。结论前交叉韧带损伤后3周内接受关节镜下前交叉韧带重建手术,有利于患者膝关节功能恢复。
Objective To investigate the effect of operation timing on the clinical outcome of arthroscopic anterior cruciate ligament reconstruction.Methods A retrospective analysis was performed on the clinical data of 88 patients(88 knees)undergoing arthroscopic anterior cruciate ligament reconstruction surgery admitted to The Air Force Hospital of PLA Northern Theater from September 2017 to January 2020.Patients were divided into two groups based on time from injury to surgery:group A(n=41)underwent reconstructive surgery within 3 weeks of injury,and group B(n=47)underwent reconstructive surgery more than 6 weeks after injury.Lysholm score,International Knee Documentation Committee(IKDC)score,maximum knee flexion angle,positive ratio of front drawer test and Lachman test were compared between the two groups before and at the last follow-up.At the same time,the complications of the two groups were observed during operation.Results All patients underwent smooth operation,no anesthesia accident or death cases,no postoperative vascular nerve injury and knee infection and other complications.The postoperative followup time was 9-12 months,with an average of 10 months.No second knee surgery was performed in all patients during the follow-up period.Lysholm score,IKDC score and maximum knee flexion angle in group A and group B at the last follow-up were higher than those before surgery,and Lysholm score and IKDC score in group A at the last follow-up were higher than those in group B,with statistically significant differences(P<0.05).In group A,there were 7 cases(17.1%)with medial meniscus injury,11 cases(26.8%)with lateral meniscus injury and 9 cases(22.0%)with bilateral meniscus injury.In group B,there were 8 cases(17.0%)with medial meniscus injury,4 cases(8.5%)with lateral meniscus injury and 19 cases(40.0%)with bilateral meniscus injury.The proportion of patients with meniscus injury in the two groups was statistically significant(P<0.05).In group A,there were 8 cases(19.5%)of gradeⅠ,7 cases(17.1%)of gradeⅡ,4 cases(9.8%)of gradeⅢand 1 case(2.4%)of gradeⅣcombined with articular cartilage injury.In group B,there were 3 cases(6.4%)of gradeⅠ,7 cases(14.9%)of gradeⅡ,9 cases(19.1%)of gradeⅢand 10 cases(21.3%)of gradeⅣcombined with articular cartilage injury.The proportion of patients with articular cartilage injury between the two groups was statistically significant(P<0.05).There was no significant difference in the positive proportion of front drawer test and Lachman test between the two groups before surgery and at the last follow-up(P>0.05).The positive proportions of front drawer test and Lachman test at the last follow-up were lower than those before surgery,with statistical significance(P<0.05).Conclusion Arthroscopic anterior cruciate ligament reconstruction within 3 weeks after anterior cruciate ligament injury is beneficial to the recovery of knee function.
作者
丁海蛟
施博瀚
刘鹏
王一洋
DING Hai-jiao;SHI Bo-han;LIU Peng;WANG Yi-yang(Department of Orthopedic,The Air Force Hospital of PLA Northern Theater,Shenyang 110042,China)
出处
《临床军医杂志》
CAS
2022年第6期577-580,共4页
Clinical Journal of Medical Officers
基金
辽宁省科技计划项目(20170540974)
辽宁省科技计划项目(20170540959)
关键词
关节镜
前交叉韧带重建
手术时机
膝关节功能
关节稳定性
Arthroscopy
Anterior cruciate ligament reconstruction
Operation timing
Knee function
Joint stability
