前交叉韧带重建术应用股骨侧三种固定方式的近期临床效果比较

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目的:比较自体腘绳肌腱前交叉韧带重建术(anterior cruciate ligament reconstruction,ACLR)中股骨侧分别应用可吸收交叉钉、带鞘挤压钉和悬吊固定3种固定方式,胫骨侧均应用带鞘挤压钉予以固定的近期临床疗效。方法:收集2008年12月至2018年12月资料完整的承德医学院附属秦皇岛市第一医院诊治的前交叉韧带损伤并行手术治疗373例患者的临床资料,进行回顾性病例对照研究。股骨侧固定3种固定方式分别为可吸收交叉钉(可吸收交叉钉组)125例、带鞘挤压钉(带鞘挤压钉组)112例和悬吊固定(悬吊固定组)136例。随访时间(13.96±1.42)月;应用国际膝关节评分委员会(international knee documentation committee,IKDC)评分、Lysholm评分对患者进行评分,对其差异进行统计学分析,正态分布的计量资料以n xˉ±n s表示,3组间不同时间段的比较采用重复测量方差分析,3组样本手术时间比较采用单因素方差分析;计数资料组间比较采用n χ2检验。n 结果:(1)3组患者末次随访时均未出现感染、粘连、僵硬、神经血管损伤等并发症发生。(2)手术前、后膝关节评分比较:Lysholm评分:术前可吸收交叉钉组(65.98±1.37)分、带鞘挤压钉组(66.13±2.13)分、悬吊固定组(65.76±1.55)分;术后3个月可吸收交叉钉组(80.14±2.02)分、带鞘挤压钉组(79.70±1.98)分、悬吊固定组(79.84±1.86)分;术后12个月可吸收交叉钉组(94.56±2.35)分、带鞘挤压钉组(94.96±1.34)分、悬吊固定组(94.40±3.15)分;同组患者手术前、后评分比较差异有统计学意义(n F组内=17584.14,n P<0.001),3组患者间比较差异均无统计学意义(n F组间=2.65,n P=0.072),3组患者手术前、后评分走势无统计学意义(n F交互=1.28,n P=0.277)。IKDC评分:术前可吸收交叉钉组(62.02±1.43)分、带鞘挤压钉组(61.95±0.82)分、悬吊固定组(62.25±2.05)分;术后3个月可吸收交叉钉组(77.99±2.18)分、带鞘挤压钉组(78.13±2.02)分、悬吊固定组(77.97±2.24)分;术后12个月可吸收交叉钉组(92.68±3.21)分、带鞘挤压钉组(93.25±2.04)分、悬吊固定组(92.96±3.11)分;同组患者手术前、后评分比较差异有统计学意义(n F组内=18 338.15,n P<0.001),3组患者间比较差异无统计学意义(n F组间=0.91,n P=0.402),3组患者手术前、后评分走势无统计学意义(n F交互=0.98,n P=0.419)。(3)手术时间比较:可吸收交叉钉组(99.04±18.01)min、带鞘挤压钉组(112.88±19.79)min、悬吊固定组(83.81±16.69)min,3组比较差异有统计学意义(n F=79.74,n P<0.001),进一步3组间两两比较,悬吊固定组用时较其他两组最短(均n P<0.001)。n 结论:应用自体腘绳肌腱的ACLR近期疗效方面3种不同的股骨侧固定方式未见明显差异,且末次随访时均未出现感染、粘连、僵硬、神经血管损伤等并发症。从手术用时来看,悬吊固定组用时最短,简单易行。“,”Objective:To compare the short-term clinical effects of absorbable cross nail, sheath compression nail and suspension fixation on the femoral side and sheath compression nail on the tibial side in anterior cruciate ligament reconstruction (ACLR) with autologous hamstring tendon.Methods:The clinical data of 373 patients with anterior cruciate ligament injuries treated with surgery in the First Hospital of Qinhuangdao Affiliated to Chengde Medical College from December 2008 to December 2018 were collected for a retrospective case-control study. There were 125 cases of absorbable cross nail (absorbable cross nail group), 112 cases of sheath compression nail (sheath compression nail group) and 136 cases of suspension fixation (suspension fixation group). The mean follow-up time was (13.96±1.42) months. The international knee documentation committee (IKDC) score and Lysholm score were used to score the patients, and the differences were statistically analyzed. The measurement data of normal distribution was represented by n xˉ±n s, and repeated measurement analysis of variance was used to compare the three groups in different time periods, and the operation time of the three groups of samples was compared by one-way analysis of variance. The counting data were compared by χn 2 test.n Results:(1) There were no complications such as infection, adhesion, stiffness and neurovascular injury in the three groups at the last follow-up. (2) Comparison of preoperative and postoperative knee scores: Lysholm score: preoperative absorbable cross nail group (65.98±1.37), sheath compression nail group(66.13±2.13), suspension fixation group (65.76±1.55). Three months after operation, absorbable cross nail group (80.14±2.02), sheath compression nail group (79.70±1.98) and suspension fixation group (79.84±1.86). Twelve months after operation, there were (94.56±2.35) points in the absorbable cross nail group, (94.96±1.34) points in the sheath compression nail group and (94.40±3.15) points in the suspension fixation group.There was significant difference in the scores before and after operation in the same group (n Fintra-group=17 584.14, n P<0.001), and there was no significant difference among the three groups (n Finter-group=2.65, n P=0.072), There was no statistical significance in the trend of scores before and after operation in the three groups (n Finter-action=1.28, n P=0.277). IKDC scores: Preoperative (62.02±1.43) in absorbable cross nail group, preoperative (61.95±0.82) in sheath compression nail group, preoperative (62.25±2.05) in the suspension fixation group. Three months after operation, absorbable cross nail group (77.99±2.18), sheath compression nail group (78.13±2.02) and suspension fixation group (77.97±2.24). Twelve months after operation, the absorbable cross nail group (92.68±3.21), the sheath compression nail group (93.25±2.04) and the suspension fixation group (92.96±3.11). There was significant difference in the scores before and after operation in the same group (n Fintra-group=18 338.15, n P<0.001), and there was no significant difference among the three groups (n Finter-group=0.91, n P=0.402), and there was no significant trend in the scores before and after operation in the three groups (n Finteraction=0.98, n P=0.419). (3) Comparison of operation time: absorbable cross nail group (99.04±18.01) min, sheath compression nail group (112.88±19.79) min and suspension fixation group (83.81±16.69) min. there was significant difference among the three groups (n F=79.74, n P<0.001). Further comparison between the three groups, the time of suspension fixation group was the shortest than the other two groups (alln P<0.001).n Conclusion:There is no significant difference in the short-term efficacy of ACLR with autologous hamstring tendon among the three groups, and there were no complications such as infection, adhesion, stiffness and neurovascular injury in the last follow-up. In terms of operation time, the suspension fixation group has the shortest time and is simple and easy to operate.
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