摘要
目的探讨越顶位(OTT)重建前交叉韧带(ACL)联合改良Lemaire技术在ACL一期翻修中的临床疗效。方法病例系列研究。回顾性分析大连大学附属新华医院运动医学科2020年4月至2023年5月采用OTT联合改良Lemaire技术进行ACL一期翻修的37例患者的临床资料,其中男28例,女9例,年龄(32.7±5.7)岁。通过术前及术后3个月、术后24个月膝关节主、客观评价指标评定术后膝关节功能及手术翻修效果。其中,主观评价指标包括国际膝关节文献委员会(IKDC)评分、Lysholm评分、Tegner评分;客观评价指标包括胫骨前-后向静态位移距离、胫骨-股骨相对旋转角度、Lachman试验、轴移试验以及下肢肌力丢失比。结果末次随访时,患者均恢复至伤前运动水平,IKDC评分[术前(45.3±6.8)分、术后3个月(67.5±4.7)分、术后2年(93.2±2.3)分]、Lysholm评分[术前(57.2±2.6)分、术后3个月(72.6±2.9)分、术后2年(89.7±3.7)分]、Tegner评分[术前(3.1±0.7)分、术后3个月(4.9±0.6)分、术后2年(5.8±1.3)分]均有改善,差异均有统计学意义(均P<0.001)。胫骨前-后向静态位移距离由术前的(5.2±0.5)mm降至术后2年的(1.4±0.5)mm(P<0.001),胫骨-股骨相对旋转角度术前的6.2°±1.2°降至术后2年的1.7°±0.3°(P<0.001),且恢复至正常生理范围;术后2年Lachman试验、轴移试验均阴性;患侧下肢肌力丢失比优于术前(P<0.001)。结论利用OTT重建联合改良Lemaire技术对ACL重建失效患者进行翻修,可规避隧道问题进行一期翻修,较好地恢复膝关节的稳定和功能,临床效果满意。
Objective To investigate the clinical effect of over-the-top(OTT)reconstruction of the anterior cruciate ligament(ACL)combined with the modified Lemaire technique in one-stage ACL revision.Methods It′s a retrospective study.The clinical data of 37 patients who underwent one-stage revision of ACL using OTT combined with modified Lemaire technique from April 2020 to May 2023 in the Department of Sports Medicine of Xinhua Hospital Affiliated to Dalian University were retrospectively analyzed.There were 28 males and 9 females with a mean age of(32.7±5.7)years.The postoperative knee function and surgical revision effect were evaluated by subjective and objective evaluation indexes of the knee joint before and 3 months and 24 months after surgery.The subjective evaluation indexes included the International Knee Documentation Committee(IKDC)score,Lysholm score,and Tegner score;and the objective evaluation indexes included the anterior-posterior static displacement distance of the tibia,tibia-femur relative rotation angle,the Lachman test,the axial shift test,and the ratio of the loss of muscle strength of the lower limb.Results At the final follow-up,all patients returned to pre-injury motor level,with significant improvements in IKDC scores(45.3±6.8 preoperatively,67.5±4.7 and 93.2±2.3 at 3 months and 2 years after the operation,respectively),Lysholm scores(57.2±2.6 preoperatively,72.6±2.9 and 89.7±3.7 at 3 months and 2 years after the operation,respectively),and Tegner scores(3.1±0.7 preoperatively,4.9±0.6 and 5.8±1.3 at 3 months and 2 years after the operation,respectively)(all P<0.001).The anterior-posterior static displacement distance of the tibia reduced significantly[from(5.2±0.5)mm before the operation to(1.4±0.5)mm at 2 years postoperatively(P<0.001)];and the relative rotation angle of the tibia-femur restored to the normal physiological range,it was reduced from 6.2°±1.2°before the operation to 1.7°±0.3°2 years after(P<0.001).The Lachman test and axial shift test at 2 years postoperatively were all negative.The muscle strength loss ratio of the affected lower limb was significantly better than that before the operation(P<0.001).Conclusion The use of OTT reconstruction combined with modified Lemaire technique for revision of ACL in patients with ACL reconstruction failure can circumvent the tunnel problem for one-stage revision and better restore the stability and function of the knee joint,with ideal clinical results.
作者
李瑞欣
弓爵
向先祥
刘佳
魏志亨
王卫明
Li Ruixin;Gong Jue;Xiang Xianxiang;Liu Jia;Wei Zhiheng;Wang Weiming(Department of Sports Medicine,Affiliated Xinhua Hospital of Dalian University,Dalian 116021,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2024年第17期1486-1492,共7页
National Medical Journal of China
关键词
前交叉韧带
前交叉韧带重建
越顶位重建
改良Lemaire技术
一期翻修
Anterior cruciate ligament
Anterolateral ligament reconstruction
Over-the-top
Modified Lemaire procedure
One-stage revision
作者简介
通信作者:王卫明,Email:oldpal@126.com
