应用Rigidfix固定体系进行膝关节前交叉韧带重建术的临床疗效

Clinical therapeutic effect of arthroscopic Rigidfix system fixation on anterior cruciate ligament reconstruction

  • 摘要: 目的 研究关节镜配合股骨Rigidfix法固定进行膝关节前交叉韧带(anterior cruciate ligament,ACL)重建的术后临床疗效。 方法 根据纳入和排除标准,选择2013年9月-2014年8月共60例曾在我院取自体腘绳肌腱作为肌腱移植物,行前交叉韧带重建手术的患者。在关节镜技术配合下,应用股骨Rigidfix法固定+胫骨端界面螺钉固定法行ACL单束重建。进行术后临床疗效随访观察。记录患者术前及末次随访时的患侧膝关节功能和疼痛情况,膝关节功能随访包括前抽屉试验(anterior drawer test,ADT)、Lachman试验和轴移试验,以及患侧膝关节功能评分包括Lysholm评分、Tegner评分和国际膝关节文献委员会(International Knee Documentation Committee,IKDC)2000主观膝关节评分及膝关节动度仪KT1000测量。膝关节疼痛的随访采用主观疼痛评分。 结果 60例均获得随访,Lysholm评分由术前(31.38±5.10)分提高到3个月随访时的(60.37±5.35)分、10个月随访时的(74.7±3.51)分(P< 0.001);IKDC2000评分由术前(30.85±4.19)分提高到3个月随访时的(90.08±4.24)分、10个月随访时的(93.45±2.86)分(P< 0.001);Tegner评分由术前(1.38±0.56)分提高到3个月随访时的(7.30±0.62)分、10个月随访时的(7.80±0.57)分(P< 0.001);膝关节动度仪KT1000测量由术前的(6.98±0.56) mm降低至3个月随访的(2.95±0.52) mm、10个月随访时的(2.92±0.50) mm (P< 0.001)。患者主观膝关节疼痛有明显缓解,评分由术前(6.1±1.003)分降低到术后3个月的(0.45±0.594)分、术后10个月的(0.200±0.400)分(P< 0.001)。 结论 关节镜配合使用Rigidfix法固定自体腘绳肌腱重建膝关节前交叉韧带近期临床疗效满意,移植物固定可靠,手术操作安全简单,病人术后恢复快,效果满意。

     

    Abstract: Objective To study the clinical therapeutic effect of Rigidfix system technique + interference screw fixation on anterior cruciate ligament (ACL) reconstruction with autologous hamstring tendon. Methods Sixty patients with ACL injury admitted to our department from September 2013 to August 2014 were enrolled in this study. All of them had underwent Rigidfix system fixation at the femoral side and interference screw fixation at the tibial side for single bundle ACL reconstruction surgery with autologous hamstring tendon. Clinical therapeutic effects of patients were followed up. Knee motion test, anterior drawer test (ADT), Lachman test, pivot shift test were done and Lysholm score, International Knee Documentation Committee (IKDC) 2000 subjective knee score, Tegner score and knee motion KT1000 arthrometry and assessed pain with a verbal numeric pain rating score (0-10) including pain on moving and at rest at different time were recorded. Results The patients were all followed up at two individual time points (3rd month and 10th month after the surgery). Their Lysholm score, IKDC2000 score and Tegner score were significantly higher at 3 months and 10 months after operation than before (60.37±5.35, 74.7±3.51 vs 31.38±5.10; 90.08±4.24, 93.45±2.86 vs 30.85±4.19; 7.30±0.62, 7.80±0.57 vs 1.38±0.56, P< 0.001). Moreover, their KT1000 arthrometry length declined significantly at 3 months and 10 months after operation than before operation (2.95±0.52 mm, 2.92±0.50 mm vs 6.98±0.56 mm, P< 0.001). Postoperative patients achieved lower verbal numeric pain rating score (0.45±0.594, 0.200±0.400 vs 6.1±1.003, P< 0.001). Conclusion Arthroscopic Rigidfix system+ interference screw fixation with autologous hamstring tendon is a reliable procedure for ACL reconstruction with a satisfactory short-term therapeutic effect, a rigid fixation of implants, and a rapid recovery for the postoperative patients.

     

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