中国组织工程研究

中国组织工程研究 ›› 2019, Vol. 23 ›› Issue (26): 4170-4174.doi: 10.3969/j.issn.2095-4344.1352

• 细胞外基质材料 extracellular matrix materials • 上一篇    下一篇

关节镜下早期与晚期自体肌腱重建前交叉韧带的对比研究

李书振1，2，王  豪2，韩  杰2，梁海波2，覃  志2，孙  可1，尹  东1
  

  1. 1广西壮族自治区人民医院骨科，广西壮族自治区南宁市  530021；2广西中医药大学附属瑞康医院骨科，广西壮族自治区南宁市  530001
  • 收稿日期:2019-04-16
  • 通讯作者: 尹东，广西壮族自治区人民医院骨科，广西壮族自治区南宁市 530021
  • 基金资助:

    广西中医药大学附属瑞康医院自筹课题(RKP201006)：前交叉韧带手术重建时机的循证医学研究；项目负责人：李书振；广西自然科学基金(2017JJA140564z)：内侧半月板Ramp损伤对膝关节稳定的影响；项目负责人：李书振

Early versus late reconstruction of anterior cruciate ligament with tendon autografts under arthroscopy

Li Shuzhen1, 2, Wang Hao2, Han Jie2, Liang Haibo2, Qin Zhi2, Sun Ke1, Yin Dong1
  

  1. 1Department of Orthopedics, the People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi Zhuang Autonomous Region, China; 2Department of Orthopedics, Ruikang Hospital, Guangxi University of Chinese Medicine, Nanning 530001, Guangxi Zhuang Autonomous Region, China
  • Received:2019-04-16
  • Contact: Yin Dong, Department of Orthopedics, the People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi Zhuang Autonomous Region, China
  • Supported by:

    Self-financing Project of the Health and Family Planning Commission of Guangxi Zhuang Autonomous Region, No. RKP201006 (to LSZ); the Natural Science Foundation of Guangxi Zhuang Autonomous Region, 2017JJA140564z (to LSZ)

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摘要：

文章快速阅读：

 

文题释义：
急性前交叉韧带损伤重建手术时机的争议：一些学者主张行早期重建可增加膝关节的活动度，并且能够得到良好的预后，延迟前交叉韧带重建时间会增加关节表面的应力，会加速膝关节在长期运动中发生退行性变；另一些学者则建议晚期重建，因急性期关节内积血肿胀、炎性反应及关节囊破损，进行前交叉韧带重建术后会增加术后膝关节粘连及僵硬的风险，影响膝关节功能，因此他们推荐于损伤后1个月膝关节肿胀消失、无炎性反应症状及膝关节活动度恢复正常后再行重建。
 
 
背景：目前对急性前交叉韧带损伤重建手术时机的选择一直存在争议，一些学者认为延迟重建时间会增加关节表面应力，加速膝关节在长期运动中发生退行性变，建议行早期重建；另一些学者认为急性期关节内积血肿胀、炎性反应及关节囊破损，会增加术后膝关节粘连及僵硬的风险，建议损伤后1个月后再行重建。
目的：对比早期与晚期重建前交叉韧带的临床效果差异。
方法：纳入广西中医药大学附属瑞康医院2014年1月至2015年12月收治的83例前交叉韧带损伤患者，男48例，女35例，其中37例选择受伤≤6周内进行自体腘绳肌腱前交叉韧带重建手术(早期组)，46例选择受伤后> 6周进行自体腘绳肌腱前交叉韧带重建手术(晚期组)。术后关节镜下观察关节软骨与半月板损伤情况，术后随访评估关节稳定性(Lachman试验、轴移试验)与关节功能恢复情况(髋关节功能IKDC评分、Lysholm评分、伸屈膝受限度数、恢复膝关节正常活动度时间)。研究获得广西中医药大学附属瑞康医院伦理委员会批准。
结果与结论：①早期重建组7例、晚期重建组15例合并软骨损伤，早期重建组20例、晚期重建组26例合并半月板损伤，两组软骨损伤发生率、损伤部位、损伤程度比较差异无显著性意义(P > 0.05)，两组半月板损伤部位、损伤发生率比较差异无显著性意义(P > 0.05)；早期组半月板切除11例、缝合9例，晚期组半月板切除22例、缝合4例，两组半月板处理方式比较差异有显著性意义(P < 0.05)；②两组Lachman试验、轴移试验结果比较差异无显著性意义(P > 0.05)；③两组髋关节功能IKDC评分、Lysholm评分、伸屈膝受限度数比较差异无显著性意义(P > 0.05)；④晚期组恢复膝关节正常活动度时间短于早期组(P < 0.05)；⑤结果表明，早期与晚期前交叉韧带重建可获得一致的临床效果，但早期重建可增加半月板愈合概率。

关键词: 自体肌腱, 前交叉韧带重建, 时间因素, 关节镜检查, 稳定性, 功能, 半月板损伤

Abstract:

BACKGROUND: At present, the surgical timing for repair of acute anterior cruciate ligament injury remains controversial. Some scholars believe that delayed reconstruction will increase joint surface stress and accelerate the degenerative change of the knee joint during long-term motion and suggest early reconstruction of anterior cruciate ligament. Other scholars believe that acute intra-articular hematocele and swelling, inflammatory reaction and joint capsule damage will increase the risk of postoperative knee joint adhesion and stiffness. Therefore, they recommend reconstruction 1 month after injury.
OBJECTIVE: To investigate the clinical effects of early versus later anterior cruciate ligament reconstruction.
METHODS: Eighty-three patients with anterior cruciate ligament injury, consisting of 48 males and 35 females, who received treatment during January 2014-December 2015 in Ruikang Hospital, Guangxi University of Chinese Medicine, China were included in this study. Among these patients, 37 patients selected autologous hamstring tendon anterior cruciate ligament reconstruction at ≤ 6 weeks after injury (early reconstruction group) and 46 patients selected autologous hamstring tendon anterior cruciate ligament reconstruction at > 6 weeks after surgery (late reconstruction group). After surgery, articular cartilage and meniscus injury were observed under arthroscopy. Joint stability (Lachman test, pivot shift test) and recovery of joint function (hip joint International Knee Documentation Committee score, Lysholm score, limited degree of knee extension and flexion, time spent in recovery of normal range of motion of knee joint) were evaluated. This study was approved by the Ethics Committee of Ruikang Hospital, Guangxi University of Chinese Medicine, China.
RESULTS AND CONCLUSION: Cartilage injury occurred in 7 cases in the early reconstruction group and 15 cases in the late reconstruction group. Meniscus injury occurred in 20 cases in the early reconstruction group and 26 cases in the late reconstruction group. There were no significant differences in the incidence, location and severity of cartilage injury between the early reconstruction and late reconstruction groups (P > 0.05). There were no significant differences in the location and incidence of meniscus injury between these two groups (P > 0.05). There were 11 cases of meniscus resection and 9 cases of meniscus suture in the early reconstruction group. There were 22 cases of meniscus resection and 4 cases of meniscus suture in the late reconstruction group. No significant difference was found in Lachman test and pivot shift test results (P > 0.05). There were no significant differences in International Knee Documentation Committee score, Lysholm score and limited degree of knee extension and flexion between early and late construction groups (P > 0.05). The time spent in recovering normal range of motion of knee joint in the late reconstruction group was shorter than that in the early reconstruction group (P < 0.05). These results suggest that early and late anterior cruciate ligament reconstruction can achieve the same clinical effect, but early reconstruction can increase the probability of meniscus healing.

Key words: tendon autografts, anterior cruciate ligament reconstruction, time factor, arthroscopy, stability, function, meniscus injury

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