摘要
目的探讨LARS韧带重建前交叉韧带(anterior cruciate ligament,ACL)的手术方法和近期疗效。方法回顾分析2008年11月-2010年4月于关节镜下采用LARS韧带重建并获完整随访的80例ACL损伤患者临床资料。男51例,女29例;年龄17～43岁,平均29.2岁。致伤原因:运动伤63例,交通事故伤14例,重物砸伤3例。左膝43例,右膝37例。病程10 d～11个月。前抽屉试验、Lachman试验和轴移试验均为阳性。术前Lysholm、Irgang、Larson评分分别为(55.4±5.7)、(48.3±6.2)、(54.8±7.4)分,国际膝关节评分委员会(IKDC)评分均低于正常值。MRI检查显示ACL损伤。术中保留ACL残余纤维束。结果术后切口均Ⅰ期愈合,无感染、下肢深静脉血栓形成等术后早期并发症发生。80例均获随访,随访时间7～24个月,平均16.8个月。术后3例股骨侧螺钉外露,2例胫骨侧螺钉松动,1例伸膝受限,均对症处理。随访期间均无LARS韧带断裂、关节纤维化等并发症发生。末次随访时前抽屉试验阳性2例,Lachman试验阳性3例,轴移试验阳性3例。术后6周及末次随访时Lysholm、Irgang、Larson评分与术前比较,差异均有统计学意义(P<0.05)。术后6周及末次随访时IKDC评分正常率分别为43.75%(35/80)及97.50%(78/80)。结论 LARS韧带黏弹性较差,术中需要在偏伸直位固定避免屈曲受限,屈曲位允许移植物有轻微松弛,掌握其特殊手术技巧后重建ACL能获得较好的近期疗效。
Objective To investigate the surgical technique and short-term effectiveness of anterior cruciate ligament （ACL） reconstruction with LARS artificial ligament. Methods Between November 2008 and April 2010, eighty patients with ACL injury were treated with LARS artificial ligament under arthroscope and successfully followed up. There were 51 males and 29 females, aged from 17 to 43 years with an average of 29.2 years. The injuries were caused by sport in 63 cases, traffic accident in 14 cases, and bruise in 3 cases. There were 43 left knees and 37 right knees. The disease duration ranged from 10 days to 11 months. The anterior drawer test, Lachman test, and pivot shift test for all cases were rated as positive. The preoperative Lysholm score was 55.4±5.7, Irgang score was 48.3±6.2, and Larson score was 54.8± 7.4; and the International Knee Documentation Committee （IKDC） score was lower than normal level in all cases. Oblique coronal MRI showed ACL injury in all cases. Residual ACL and synovium were preserved during surgery. Results infection or deep venous thrombosis. All patients were followed All incisions healed by first intention without complication of up 7 to 24 months with an average of 16.8 months. There were 3 cases of screws exposure toward femoral cortical bone, 2 cases of loosening tibial screw, and 1 case of knee extension limitation, and they were cured after symptomatic treatment. No LARS artificial ligament rupture and joint fibrosis occurred during follow- up. At last follow-up, the results of anterior drawer test, Lachman test, and pivot shift test were positive in 2, 3, and 3 patients, respectively. There were significant differences in Lysholm, Irgang, and Larson scores of affected knees between preoperation and 6 weeks postoperatively, last follow-up, respectively （P 〈 0.05）. The normal rate of IKDC score were 43.75% （35/80） and 97.50% （78/80） at 6 weeks postoperatively and last follow-up, respectively. Conclusion The viscoelastic properties of LARS artificial ligament is different from that of biological materials. The graft should be fixed at a relatively extension position to avoid knee extension limitation and slight loosening of graft tension is permitted at flexion position. Good clinical result could be achieved if the technique is well applied.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2011年第8期921-924,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
前交叉韧带LARS韧带
韧带重建
近期疗效
effectiveness Anterior cruciate ligament LARS artificial ligament Ligament reconstruction Short-term
作者简介
通讯作者：杨柳，教授，博士生导师，研究方向：关节外科、组织工程，E-mail：jointsurgery@163．com
