中国修复重建外科杂志

中国修复重建外科杂志

倒刺线环扎固定技术对前交叉韧带保残重建的疗效影响

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目的探讨前交叉韧带保残重建术中采用倒刺线环扎固定的可行性以及对疗效的影响。方法2014 年 2 月—2016 年 1 月将 96 例(96 膝)符合选择标准的前交叉韧带损伤患者纳入研究,随机分为两组,每组 48 例。两组均采用自体肌腱行前交叉韧带保留残端重建术,其中试验组采用倒刺线环扎固定残端,对照组采用传统缝线固定残端。两组患者年龄、性别、损伤侧别、受伤至手术时间以及术前膝关节稳定性(KT-1000 检测)及国际膝关节文献委员会(IKDC)评分、Lyshlom 评分等一般资料比较,差异均无统计学意义(P>0.05)。比较两组术后膝关节稳定性、膝关节功能(IKDC 及 Lyshlom 评分)、本体感觉情况(被动角度重复试验)以及 Cyclops 病变发生情况。结果两组术后切口均Ⅰ期愈合。对照组 44 例患者获随访,随访时间 26~47 个月,平均 36.6 个月;试验组 45 例患者获随访,随访时间 26~48 个月,平均 35.6 个月。末次随访时,两组 IKDC 评分、Lysholm 评分、KT-1000 检测与术前比较,差异均有统计学意义(P<0.05);两组间比较差异均无统计学意义(P>0.05)。术后 1、2 年试验组及对照组本体感觉比较,以及每组内术后1年和2年间比较,差异均无统计学意义(P>0.05)。随访期间 MRI 复查显示,术后 6 个月、1 年及 2 年时试验组 Cyclops 病变发生率分别为 0、4.44%(2/45)、4.44%(2/45),对照组分别为 13.6%(6/44)、13.6%(6/44)、20.5%(9/44);术后 6 个月及 2 年两组间发生率比较差异有统计学意义(P=0.012;P=0.022),术后 1 年时两组间比较差异无统计学意义(P=0.157)。结论前交叉韧带保残重建术中采用倒刺线环扎固定残端能够降低术后 Cyclops 病变的发生率,但是对术后膝关节功能恢复无明显优势。

ObjectiveTo investigate the feasibility and effectiveness of a novel remnant-preserving anterior cruciate ligament (ACL) reconstruction with bidirectional barbed suture.MethodsBetween February 2014 and January 2016, 96 patients (96 knees) with ACL injury who met the inclusion criteria were recruited and randomly divided into 2 groups (n=48). All patients underwent ACL reconstruction with autologous tendon. The tibial remnant was fixed with PDS-Ⅱ suture (control group) and bidirectional barbed suture (trial group). There was no significant difference in age, gender, injury side, the interval from injury to operation, and preoperative knee stability (KT-1000 test), International Knee Documentation Committee (IKDC) score, and Lysholm score (P>0.05). The knee stability (KT-1000 test), IKDC score, Lysholm score, proprioception, and Cyclops lesion after operation were recorded.ResultsAll incisions healed by first intention in both groups. Forty-four patients in control group were followed up 26-47 months (mean, 36.6 months), and 45 patients in trial group were followed up 26-48 months (mean, 35.6 months). At last follow-up, the IKDC score, Lysholm score, and KT-1000 test were significantly improved when compared with preoperative ones in both groups (P<0.05); but no significant difference was found between 2 groups (P>0.05). There was no significant difference in proprioception between 2 groups at 1 and 2 years after operation, and between 1 year after operation and 2 years after operation (P>0.05) in the same group. The incidences of Cyclops lesion at 6 months, 1 year and 2 years after operation were 0, 4.44% (2/45), and 4.44% (2/45) in trial group, and 13.6% (6/44), 13.6% (6/44), 20.5% (9/44) in control group, showing significant differences between 2 groups at 6 months and at 2 years after operation (P=0.012; P=0.022) and no significant difference at 1 year after operation (P=0.157).ConclusionThe remnant-preserving ACL reconstruction with bidirectional barbed suture can decrease the incidence of Cyclops lesions. However, this technique can not improve the effectiveness in terms of the clinical function and stability compared with the traditional technique.

关键词: 前交叉韧带重建; 保残重建; 倒刺线环扎固定; Cyclops病变

Key words: Anterior cruciate ligament reconstruction; remnant-preserving reconstruction; bidirectional barbed suture; Cyclops lesion

引用本文: 何青松, 庄雷霆, 安子豪, 徐文南, 张杭州. 倒刺线环扎固定技术对前交叉韧带保残重建的疗效影响. 中国修复重建外科杂志, 2019, 33(2): 149-153. doi: 10.7507/1002-1892.201809132 复制

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