关节镜下锚钉保残与常规前交叉韧带重建比较

Comparison of arthroscopic anterior cruciate ligament reconstructions with remnant preservation by suture anchor versus without remnant preservation

摘要:

［目的］比较保残前交叉韧带（anterior cruciate ligament, ACL）重建与常规 ACL 重建的中短期临床疗效。［方法］回顾性分析 2019 年 3 月—2021 年 3 月行 ACL 重建术 51 例患者的临床资料。依据术前医患沟通结果和术中镜下所见 ACL 残端存留情况，25 例采用 ACL 重建联合带线锚钉紧缩缝合韧带残端（保残组）；26 例因残端质量差，仅行常规 ACL 重建（常规组）。 比较两组围手术期、随访及影像结果。［结果］51 例患者均顺利完成手术，未出现血管、神经损伤。保残组的手术时间显著长于常规组 （P<0.05），下地行走时间显著早于常规组 （P<0.05）。所有患者随访时间平均 （13.35±1.18） 个月，保残组恢复完全负重活动时间显著早于常规组（P<0.05）。随时间推移，两组轴移试验和 Lachman 试验显著改善（P<0.05）；Lysholm 评分、IK- DC 2000 评分均显著增加 （P<0.05）；但膝关节被动角度再生试验无显著变化 （P>0.05）。术后 3 个月，保残组 Lysholm 评分、 IKDC 2000 评分和膝关节被动角度再生试验均显著优于常规组（P>0.05），但是，术后 6、12 个月上述指标的差异已无统计学意义（P>0.05）。影像方面，两组股骨隧道位置及胫骨隧道位置优良率的差异均无统计学意义（P>0.05）。术后 3 个月时，保残组在骨隧道扩大方面显著优于常规组（P<0.05），但术后 6、12 个月，两组骨隧道扩大及 K-L 关节退变分级的差异均无统计学意义（P>0.05）。［结论］相比常规 ACL 重建术，保残 ACL 重建短期膝功能及本体感觉恢复更好。

Abstract:

[Objective] To compare the short- and medium-term clinical outcomes of anterior cruciate ligament (ACL) reconstruction with remnant preservation by suture anchor versus conventional ACL reconstruction without remnant preservation. [Methods] A retrospec- tive study was conducted on 51 patients who underwent arthroscopic ACL reconstruction from March 2019 to March 2021. According to pre- operative doctor-patient communication and intraoperative arthroscopic findings of ACL remnant, 25 patients received ACL reconstruction combined with remnant preservation (RP) by suture anchor tightening, while the other 26 patients had the conventional (CV) ACL recon- struction performed only due to poor remnant quality. The perioperative period, follow-up and imaging results were compared between the two groups. [Results] All the 51 patients underwent corresponding surgical procedures successfully without vascular or nerve injury. Al- though the RP group consumed significantly longer operation time than the CV group (P＜0.05) , the former returned postoperative ambula- tion significantly earlier than the latter (P＜0.05) . All the patients in both groups were followed up for (13.35±1.18) months on an average, and the RP group resumed full weight-bearing activity significantly earlier than the CV group (P＜0.05) . The pivot shift test and Lachman test significantly improved (P＜0.05) , while the Lysholm and IKDC 2000 scores significantly increased in both groups over time (P＜0.05) , regardless of no significant change in passive angle regeneration of the knee (P＞0.05) . At 3 months after operation, the RP group proved significantly superior to the CV group in terms of Lysholm and IKDC 2000 scores, as well as passive angle regeneration test (P＞0.05) , whereas which became not statistically significant at 6 months and 12 months after operation (P＞0.05) . Radiographically, there was no sig- nificant difference in the excellent rate of femoral and tibial tunnel location between the two groups (P＞0.05) . At 3 months after operation the RP group was significantly superior to the CV group in term of bone tunnel enlargement (P＜0.05) , but there was no significant differ- ence in bone tunnel enlargement and Kellgren- Lawrence grade between the two groups at 6 months and 12 months after operation (P＞ 0.05) . [Conclusion] Compared with the conventional ACL reconstruction, the remnant-preserving ACL reconstruction does achieve better knee function and proprioceptive recovery in short-term.