镜下全内技术后交叉韧带重建与常规技术比较

Comparison of posterior cruciate ligament reconstruction by allinside and conventional arthroscopic techniques

摘要:

[目的] 比较镜下全内技术与常规技术重建后交叉韧带（posterior cruciate ligament, PCL） 的临床结果。[方法] 回顾性分析2016 年7 月—2021 年7 月镜下重建PCL 74 例患者的临床资料。依据医患沟通结果，31 例采用自体半腱肌肌腱为移植物，以全内技术PCL 重建（全内组），另外43 例采用异体肌腱为移植物，常规镜下PCL 重建（常规组）。比较两组围手术期、随访及影像资料。[结果] 全内组在切口总长度[(7.1±1.3) cm vs (10.3±2.4) cm, P＜0.001]、下地行走时间[(3.4±2.1) d vs (5.6±3.2) d,P＜0.001]、早期并发症发生率（3.2% vs 9.3%, P=0.043）、住院时间[(7.4±1.8) d vs (10.3±3.6) d, P＜0.001] 均显著优于常规组。全内组恢复完全负重活动时间显著早于常规组[(93.6±11.7) d vs (128.4±12.4) d, P＜0.001]。术后两组VAS 评分、Lysholm 评分、IKDC评级、膝伸屈ROM、后抽屉试验和后向Lachman 试验均显著改善（P＜0.05），术后3 个月和末次随访时，全内组的膝伸屈活动度[(124.4±3.6)° vs (116.5±3.2)°, P＜0.001; (138.7±3.6)° vs (132.6±5.8)°, P＜0.001]、Lysholm 评分[(124.4±3.6) vs (116.5±3.2), P＜0.001;(138.7±3.6) vs (132.6±5.8), P＜0.001] 和IKDC 评级均显著优于常规组。影像方面，术后3 个月，全内组股骨隧道内口缩小[例, 缩小/无变化/扩大, (23/8/0) vs (13/27/3), P＜0.001] 占比显著优于常规组（P＜0.05）。[结论] 应用镜下全内技术PCL 重建膝PCL 的临床结果优于常规镜下PCL 重建。

Abstract:

[Objective] To compare the clinical outcomes of posterior cruciate ligament (PCL) reconstruction by all-inside and conven-tional arthroscopic techniques. [Methods] A retrospective study was performed on 74 patients who underwent arthroscopic PCL reconstruc-tion from July 2016 to July 2021. According to doctor-patient discussion, 31 patients received all-inside PCL reconstruction with autoge-nous semitendinosus tendon graft (the all-inside group), while the other 43 patients underwent conventional arthroscopic PCL reconstruc-tion with allogeneic tendon graft (the routine group). The perioperative, follow-up and imaging data of the two groups were compared. [Results] The all-inside group proved significantly superior to the routine group in terms of total incision length [(7.1±1.3) cm vs (10.3±2.4)cm, P＜0.001], the walking time [(3.4±2.1) days vs (5.6±3.2) days, P＜0.001], early complication rate (3.2% vs 9.3%, P=0.043) and hospitalstay [(7.4±1.8) days vs (10.3±3.6) days, P＜0.001]. In addition, the all-inside group resumed full weight-bearing activities significantly earli-er than the routine group [(93.6±11.7) days vs (128.4±12.4) days, P＜0.001]. The VAS score, Lysholm score, IKDC grade, knee flexion-ex-tension ROM, posterior drawer test and backward Lachman test significantly improved in both groups over time (P＜0.05). The all-insidegroup was significantly better than the routine group in terms of knees ROM [(124.4±3.6)° vs (116.5±3.2)°, P＜0.001; (138.7±3.6)° vs(132.6±5.8)°, P＜0.001], Lysholm score [(124.4±3.6) vs (116.5±3.2), P＜0.001; (138.7±3.6) vs (132.6±5.8), P＜0.001] and IKDC grades 3months postoperatively and at the latest follow-up. Regarding imaging, the all-inside group was also significantly better than the routinegroup in femoral tunnel variation [case, reduced/no change/enlargement, (23/8/0) vs (13/27/3), P＜0.001]. [Conclusion] The all-inside ar-throscopic PCL reconstruction is superior in term of clinical consequence to the conventional arthroscopic PCL reconstruction for this liga-ment rupture.