前交叉韧带部分损伤保留残束与标准重建比较

Comparison of the selective bundle reconstruction versus standard counterpart for partial anterior cruciate ligament tear

摘要:

[目的] 探讨前交叉韧带 （anterior cruciate ligament, ACL） 部分损伤保留残束与标准重建的临床效果。[方法] 回顾性分析本院 2016 年 10 月—2020 年 1 月收治的 36 例术中确诊为 ACL 部分损伤患者的临床资料，其中 2016 年 10 月—2018 年 1 月的连续 17 例行标准 ACL 重建手术（常规组），2018 年 2 月—2020 年 1 月的连续 19 例行保残束选择 ACL 束重建（保残组）。 比较两组围手术期、随访及影像结果。[结果]两组均顺利完成手术，两组手术时间、合并半月板损伤、合并软骨损伤、切口愈合等级、住院时间的差异均无统计学意义 （P＞0.05）。所有患者随访 （32.8±6.5） 个月。术后 12 个月保残组的 Lysholm 评分、IKDC 评分显著优于常规组（P＞0.05）。术后 24 个月，两组间松弛度侧侧差、轴移试验、Lachman 试验、Lysholm 评分、IK- DC 评分的差异均无统计学意义 （P＞0.05）。保残组重返运动时间显著早于常规组 （P＜0.05）。至末次随访时，重返运动率保残组为 47.4% （9/19），常规组为 47.1% （8/17），两组间差异无统计学意义 （P＞0.05）。影像方面，两组术后骨隧道定位优良率差异均无统计学意义（P＞0.05）。术后 12 个月，两组骨隧道扩大发生率的差异无统计学意义（P＞0.05）。[结论]ACL 部分损伤选择束重建联合快速康复早期功能恢复更好，重返运动时间更短，是治疗 ACL 部分损伤的较好选择。

Abstract:

[Objective] To compare the clinical results of selective bundle reconstruction with the remnant bundle preservation (SBRRP) versus standard single-bundle reconstruction (SSBR) for partial anterior cruciate ligament (ACL) tear. [Methods] A retrospective study was conducted on 36 patients who received arthroscopic ACL reconstruction for partial ACL tear in our hospital from October 2016 to Janu- ary 2020. Of them, 17 consecutive patients received SSBR from October 2016 to January 2018, whereas 19 consecutive patients received SNR-RP from February 2018 to January 2020. The documents regarding perioperative period, follow-up and images were compared be- tween the two groups. [Results] All patients in both groups had corresponding ACL reconstructions performed smoothly, without significant differences in terms of operation time, combined meniscus injury and cartilage injury, incision healing grade, hospital duration between the two groups (P＞0.05). All the patients were followed up for (32.8±6.5) months on a mean. The SBR-RP proved significantly superior to the SSBR in terms of the Lysholm and IKDC scores 12 months after surgery (P＜0.05), regardless of that there were no significant differences in side-side difference of relaxation, pivot shift test, Lachman test, Lysholm score and IKDC score between the two groups 24 months postoper- atively (P＞0.05). The patients in the SBR-RP group resumed sports activity significantly earlier than those in the SSBR group (P＜0.05). Up to the last follow-up the rate of returning to exercise was 47.4% (9/19) in the SBR-RP group, while 47.1% (8/17) in the SSBR group, which was not significantly different between them (P＞0.05). On imaging, there was no significant difference in the excellent and good rate of bone tunnel placement between the two groups (P＞0.05), moreover, there was no significant difference in the incidence of bone tunnel enlarge- ment between the two groups 12 months after surgery (P＞0.05). [Conclusion] Selective bundle reconstruction with remnant bundle preser- vation is a better choice for partial ACL tear with better early functional recovery and shorter time to return exercise over the standard sin- gle bundle reconstruction.