自体腘绳肌腱移植重建前交叉韧带的关节镜下二次探查(附514例报告)
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广州中医药大学第八临床医学院(佛山市中医院) 运动医学科,广东 佛山 528000

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何利雷,E-mail:drhelilei@163.com;Tel:13825565825

基金项目:

佛山市“十四五”医学培育专科项目(No:FSPY145204);广东省卫生健康委项目(No:A2022081)


Second-look arthroscopic findings after anterior cruciate ligament reconstruction using hamstring tendon autograft (514 cases)
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Department of Sports Medicine, the Eighth Clinical Medical College of Guangzhou University of Traditional Chinese Medicine (Foshan Hospital of Traditional Chinese Medicine), Foshan, Guangdong 528000, China

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    摘要:

    目的 评估采用自体腘绳肌腱重建膝关节前交叉韧带(ACL)的临床疗效,并通过二次关节镜探查,进一步观察移植物的术后变化和恢复情况。方法 回顾性分析2015年5月-2018年6月该院接受自体腘绳肌腱重建ACL手术,且术后随访1年以上的514例ACL撕裂患者的临床资料。采用Lysholm评分、国际膝关节文献委员会(IKDC)评分和Tegner评分体系,以及轴移试验和Lachman试验,评估膝关节功能恢复情况和稳定性。在二次关节镜探查时,重点观察重建韧带的滑膜覆盖情况、连续性,以及膝关节内结构是否存在异常。结果 ACL重建至二次探查时间为12~28个月,平均20个月;有2例术后发生了感染,经关节镜下清理和引流治疗后顺利康复,其他患者未见感染和移植物吸收等术后并发症;在二次探查时,Lysholm评分从术前的(43.56±9.89)分提高至术后的(92.21±6.12)分,差异有统计学意义(P < 0.05);IKDC评分从术前的(20.32±7.87)分,提高至术后的(85.67±10.43)分,差异有统计学意义(P < 0.05);Tegner评分由术前的(4.31±0.82)分,提高至术后的(6.61±1.21)分,差异有统计学意义(P < 0.05);375例患者韧带完整,139例患者韧带部分撕裂,447例患者韧带紧张,67例患者韧带松弛,435例患者重建的ACL韧带较好,79例患者重建ACL韧带欠佳。轴移试验和Lachman试验结果与术前比较,差异均有统计学意义(P < 0.05);有188例患者重返运动,占总患者的36.58%。结论 使用自体腘绳肌腱进行ACL重建术,能够有效地恢复膝关节的功能和稳定性,随访1年以上,患者ACL移植物血管化和滑膜化程度好,但要注重术后系统康复训练。

    Abstract:

    Objective To evaluate the clinical outcomes of 514 cases of anterior cruciate ligament (ACL) reconstruction using hamstring tendon autograft and to observe postoperative changes and recovery of the grafts through second-look arthroscopy.Methods This retrospective study collected data from 514 patients who underwent ACL reconstruction with hamstring tendon autograft between May 2015 and June 2018, with a follow-up of at least one year. Knee function recovery and stability were assessed using the Lysholm score, International Knee Documentation Committee (IKDC) score, and Tegner score, along with the pivot shift test and Lachman test. During the second-look arthroscopy, key observations included the synovial coverage, continuity of the reconstructed ligament, and any intra-articular abnormalities.Results The time interval between ACL reconstruction and second-look arthroscopy ranged from 12 to 28 months, with an average of 20 months. Postoperative infection occurred in 2 cases, both of which were successfully treated with arthroscopic debridement and drainage. No other patients experienced infections, graft resorption, or other complications. At the second-look arthroscopy, the Lysholm score significantly improved from (43.56 ±9.89) preoperative to (92.21 ± 6.12) postoperatively, the difference was statistically significant (P < 0.05); The IKDC score increased from (20.32 ± 7.87) to (85.67 ± 10.43), the difference was statistically significant (P < 0.05); The Tegner score improved from (4.31 ± 0.82) to (6.61 ± 1.21), the difference was statistically significant (P < 0.05). Second-look arthroscopy revealed that the ligament remained intact in 375 patients, with partial tears in 139 patients, ligament tension was maintained in 447 patients, while 67 patients had laxity, the reconstructed ACL graft was deemed to be in good condition in 435 patients and suboptimal in 79 patients, there were significant differences observed in pre- and post- pivot shift test and Lachman test (P < 0.05); Among the 514 patients, 188 (36.58%) successfully returned to sport.Conclusion ACL reconstruction using hamstring tendon autograft effectively restores knee function and stability. In patients followed for more than one years, the grafts show good vascularization and synovial coverage. Emphasis should be placed on systematic postoperative rehabilitation to optimize recovery.

    图1 ACL重建术后重返运动患者的饼图Fig.1 Pie graph of patients returning to exercise after ACL reconstruction
    表 1 514例患者膝关节功能及稳定性评估Table 1 Evaluation of knee function and stability in 514 patients
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李炎烨,卢明峰,赵立连,许挺,邢基斯,李世林,严素敏,何利雷.自体腘绳肌腱移植重建前交叉韧带的关节镜下二次探查(附514例报告)[J].中国内镜杂志,2025,31(5):12-20

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  • 收稿日期:2024-05-17
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  • 在线发布日期: 2025-06-11
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