对比分析单束不同方式保残重建治疗前交叉韧带断裂

doi:10.3877/ cma.j.issn.1674-134X.2025.02.005

目的

对比分析关节镜下单束悬吊保残重建、袖套保残重建与非保残重建治疗前交叉韧带断裂的临床疗效。

方法

回顾性分析2020年1月至2022年6月深圳平乐骨伤科医院（深圳市坪山区中医院）骨关节·运动医学科收治和随访的125例关节镜下自体腱移植单束重建治疗前交叉韧带断裂患者的临床资料。纳入标准：年龄在16～50岁间，受伤至手术时间小于3周，MRI提示前交叉韧带连续性及完整性断裂；对膝关节功能恢复要求较高。排除标准：合并有骨折、侧副韧带损伤或其他自身免疫性关节疾病患者。其中男性87例、女性38例；根据重建方式不同分为悬吊组43例（悬吊保残重建）、袖套组41例（袖套保残重建）和非保残组41例（清理残端非保残重建）。术后3组患者行相同的功能康复训练，通过比较分析3组患者的手术时间，术前与术后6、12个月 Lysholm膝关节评分和国际膝关节文献委员会评分（IKDC）膝关节功能评分、KT-2000膝关节稳定性检测、被动活动察觉阈值（TTDPM）测定本体感觉及术后定期完善患膝MRI 检查，通过方差分析与卡方检验评估临床疗效。

结果

本组研究患者均获随访，随访时间12～36个月，平均（17.5±2.4）个月，袖套组出现7例独眼征、逗号征或过伸碰撞等并发症，悬吊组和非保残组未出现。3组手术时间相近，差异无统计学意义（F=0.257，P>0.05）。术后6个月，Lysholm评分、IKDC评分悬吊组为（84.5±3.3）、（81.1±2.9）分，最高，依次高于袖套组（82.1±3.0）、（79.6±3.2）分及非保残组（80.6±4.1）、（78.0±3.7）分，3组间比较差异有统计学意义（F=1.427、2.502，均为P<0.05）；KT-2000检测悬吊组（2.18±0.24）mm最低，依次低于袖套组（2.25±0.38）mm及非保残组（2.32±0.21）mm，3组间比较差异有统计学意义（F=5.483，P<0.05）；TTDPM测定悬吊组（3.69±0.31）°最低，依次低于袖套组（4.05±0.42）°及非保残组（4.37±0.28）°，3组间比较差异有统计学意义（F=2.912，P<0.05）。术后12个月，3组Lysholm、IKDC评分、KT-2000检测相近，差异无统计学意义（均为P>0.05）；TTDPM测定悬吊组（1.79±0.22）°为最低，依次低于袖套组（2.05±0.51）°及非保残组（2.28±0.19）°，3组间比较差异有统计学意义（F=1.887，P<0.05）。术后3、6、12个月患膝MRI检查示：肌腱移植物显影良好，形态饱满；术后相应时间点，悬吊组移植物信号强度与信噪比（SNQ）均显著小于袖套组及非保残组。

结论

关节镜下自体腱移植单束保残重建治疗前交叉韧带断裂有利于重建移植物腱骨愈合、韧带重塑及本体感觉的恢复促进患肢功能康复；悬吊保残重建可恢复并维持残端组织张力，避免形成独眼征、逗号征及过伸碰撞等并发症。

关键词: 前交叉韧带损伤, 关节镜, 前交叉韧带重建

Objective

To compare and analyze the clinical efficacy of the treatment of acute anterior cruciate ligament (ACL) rupture by single-bundle reconstruction among with suspension remnant-preserving,sleeve remnant-preserving,and non-remnant-preserving under arthroscopic.

Methods

A retrospective analysis was conducted on clinical data from 125 patients undergoing arthroscopic autograft single-bundle reconstruction for ACL rupture in the Department of Orthopedics and Sports Medicine between January 2020 and June 2022. Inclusion criteria: age were 16 to 50 years; all the patients underwent surgery within three weeks after injury; MRI confirmed complete disruption of continuity and integrity of ACL; patients had high demands for functional recovery of the knee joint. Exclusion criteria: patients with concomitant bone fractures,collateral ligament injuries, or other autoimmune joint diseases. There were 87 males and 38 females among the enrolled patients. Based on surgical techniques, patients were stratified into three groups: suspension group using suspension remnant-preserving reconstruction (n=43), sleeve group adopting sleeve remnantpreserving reconstruction (n=41), and debridement group adopting non-remnant-preserving reconstruction with debridement (n=41). All three groups underwent identical postoperative functional rehabilitation protocols. Clinical efficacy was comprehensively assessed by comparing operative duration, Lysholmscores and International Knee Documentation Committee (IKDC) knee function scores preoperatively and at six, 12 months postoperatively, KT-2000 arthrometer measurements for knee stability, threshold to detect passive motion (tTDPM) for proprioception assessment, and regular postoperative MRI examinations of the affected knee. Statistical analyses included one-way analysis of variance (ANOVA) and chi square tests.

Results

All the patients in this study completed follow-up ranging from 12 to 36 months, (17.5±2.4) months on average. The sleeve group exhibited seven cases of complications, including cyclops lesion, comma sign, or hyperextension impingement, whereas no such complications were observed in the suspension group or debridement group.Operative durations were compared among three groups, with no statistically significant differences (F=0.257,P>0.05). At six months after surgery, the suspension group demonstrated the highest Lysholm scores (84.5±3.3)and IKDC scores (81.1±2.9) , followed by the sleeve group［Lysholm score (82.1±3.0), IKDC (79.6±3.2)］and debridement group［Lysholm score (80.6±4.1), IKDC (78.0±3.7)］, with statistically significant differences among the three groups (F=1.427, 2.502, both P<0.05). KT-2000 arthrometer measurements revealed the lowest side-to-side anterior laxity in the suspension group (2.18 ± 0.24 mm), significantly lower than the sleeve group (2.25±0.38) mm and debridement group (2.32±0.21) mm (F=5.483, P<0.05). TTDPM assessments showed superior proprioception in the suspension group (3.69±0.31)°, outperforming the sleeve group (4.05±0.42) ° and debridement group (4.37±0.28°) (F=2.912, P<0.05). At 12 months postoperatively,Lysholm scores, IKDC scores, and KT-2000 arthrometer measurements were comparable among the three groups, with no statistically significant differences (P>0.05). TTDPM assessments demonstrated significantly better proprioception in the suspension group (1.79±0.22)°, which was lower than the sleeve group (2.05±0.51)°and debridement group (2.28±0.19)°, showing statistically significant intergroup differences (F=1.887,P<0.05).MRI examinations of theinvovledknees at three, six, and 12 months after surgerydemonstrated wellvisualized tendon grafts with robust structural morphology. At all time points, the suspension group exhibited significantly lower graft signal intensity and signal-to-noise quotient (SNQ) compared to the sleeve group and debridement group.

Conclusions

Arthroscopic autograft single-bundle remnant-preserving reconstruction for ACL rupture facilitates graft-bone healing, ligament remodeling, and proprioceptive recovery, thereby enhancing functional rehabilitation of the affected limb. The suspension remnant-preserving technique restores and maintains tension in residual ligamentous tissues, effectively preventing complications such as cyclops lesion, comma sign, and hyperextension impingement.

Key words: Anterior cruciate ligament injuries, Arthroscope, Anterior cruciate ligament reconstruction

图1 膝关节镜下高强线穿入髓袢中返折

Figure 1 High strength thread inserted into the pulp loop under knee arthroscope

图2 高强线编织缝合

Figure 2 High strength thread braided suture anterior cruciate ligament stumP

图3 膝关节镜下残端悬吊打结固定

Figure 3 Anterior cruciate ligament stump suspended tension knot fixation under knee arthroscope

图4 膝关节镜下探查重建ACL（前交叉韧带）张力

Figure 4 Arthroscopic exploration and reconstruction of anterior cruciate ligament tension

图5 膝关节镜下胫骨止点端袖套保残重建ACL（前交叉韧带）

Figure 5 The residual root tissue of ACL (anterior cruciate ligament) was preserved and reconstructed under knee arthroscope

图6 膝关节镜下非保残重建ACL（前交叉韧带）

Figure 6 ACL (anterior cruciate ligament) residual root tissue was completely removed and reconstructed under knee arthroscope

表1 患者一般资料比较

Table 1 Comparison of general data of patients

组别Groups	例数Number of cases	性别（男/女）Gender (male/female)	年龄［岁，（ $\overset{ˉ}{x}$ ± s ）］Age（years）	左膝/右膝（例）Left knee/right knee	运动伤/交通伤（例）Sports-related injury/traffc injury	受伤至手术时间［个月，（ $\overset{ˉ}{x}$ ± s ）］Time from injury to surgery（months）
悬吊组Suspension group	43	25/18	28. 1±3. 8	23/20	33/10	2. 6±1. 5
袖套组Sleeve group	41	22/19	29. 4±4. 3	24/17	32/9	3. 5±2. 2
非保残组Debridement group	41	23/18	28. 3±5. 1	20/21	29/12	3. 1±1. 4
统计值Statistic al values		χ ²=0. 40	F=0. 25	χ ²=0. 95	χ ²=0. 18	F=0. 24
P值		>0. 05	>0. 05	>0. 05	>0. 05	>0. 05

表1 患者一般资料比较

Table 1 Comparison of general data of patients

组别Groups	例数Number of cases	性别（男/女）Gender (male/female)	年龄［岁，（ $\overset{ˉ}{x}$ ± s ）］Age（years）	左膝/右膝（例）Left knee/right knee	运动伤/交通伤（例）Sports-related injury/traffc injury	受伤至手术时间［个月，（ $\overset{ˉ}{x}$ ± s ）］Time from injury to surgery（months）
悬吊组Suspension group	43	25/18	28. 1±3. 8	23/20	33/10	2. 6±1. 5
袖套组Sleeve group	41	22/19	29. 4±4. 3	24/17	32/9	3. 5±2. 2
非保残组Debridement group	41	23/18	28. 3±5. 1	20/21	29/12	3. 1±1. 4
统计值Statistic al values		χ ²=0. 40	F=0. 25	χ ²=0. 95	χ ²=0. 18	F=0. 24
P值		>0. 05	>0. 05	>0. 05	>0. 05	>0. 05

表2 患者膝关节功能Lysholm评分与IKDC评分比较（）

Table 2 Comparisons of IKDC and Lysholm scores of knee joint function in the pateints

组别Groups	例数Number of cases	Lysholm评分			IKDC评分
组别Groups	例数Number of cases	术前Before operation	术后6个月Six months after operation	术后12个月12 months after operation	术前Before operation	术后6个月Six months after operation	术后12个月12 months after operation
悬吊组Suspension group	43	45. 9±2. 7	84. 5±3. 3^acd	87. 1±3. 1^ab	42. 3±3. 2	81. 1±2. 9^acd	84. 3±2. 9^ab
袖套组Sleeve group	41	45. 1±1. 8	82. 1±3. 0^ac	86. 5±2. 2^ab	42. 1±2. 6	79. 6±3. 2^ac	84. 2±3. 5^ab
非保残组Debridement group	41	45. 0±1. 9	80. 6±4. 1^a	86. 1±1. 3^ab	43. 1±3. 4	78. 0±3. 7^a	84. 0±3. 8^ab
F值		0. 769	1. 427	0. 801	1. 076	2. 502	1. 208
P值		>0. 05	0. 021	>0. 05	>0. 05	0. 016	>0. 05

表2 患者膝关节功能Lysholm评分与IKDC评分比较（）

Table 2 Comparisons of IKDC and Lysholm scores of knee joint function in the pateints

组别Groups	例数Number of cases	Lysholm评分			IKDC评分
组别Groups	例数Number of cases	术前Before operation	术后6个月Six months after operation	术后12个月12 months after operation	术前Before operation	术后6个月Six months after operation	术后12个月12 months after operation
悬吊组Suspension group	43	45. 9±2. 7	84. 5±3. 3^acd	87. 1±3. 1^ab	42. 3±3. 2	81. 1±2. 9^acd	84. 3±2. 9^ab
袖套组Sleeve group	41	45. 1±1. 8	82. 1±3. 0^ac	86. 5±2. 2^ab	42. 1±2. 6	79. 6±3. 2^ac	84. 2±3. 5^ab
非保残组Debridement group	41	45. 0±1. 9	80. 6±4. 1^a	86. 1±1. 3^ab	43. 1±3. 4	78. 0±3. 7^a	84. 0±3. 8^ab
F值		0. 769	1. 427	0. 801	1. 076	2. 502	1. 208
P值		>0. 05	0. 021	>0. 05	>0. 05	0. 016	>0. 05

表3 患者膝关节稳定性KT-2000检测比较［mm，（）］

Table 3 Knee stability comparison of patients by KT-2000 test

组别Groups	例数Number of cases	术前Before operation	术后6个月Six months after operation	术后12个月12 months after operation
悬吊组Suspension group	43	8. 93±2. 33	2. 18±0. 24^acd	1. 99±0. 21^ab
袖套组Sleeve group	41	9. 13±1. 86	2. 25±0. 38^ac	2. 01±0. 32^ab
非保残组Debridement group	41	8. 96±1. 97	2. 32±0. 21^a	2. 01±0. 18^ab
F值		3. 762	5. 483	2. 826
P值		>0. 05	0. 016	>0. 05

表3 患者膝关节稳定性KT-2000检测比较［mm，（）］

Table 3 Knee stability comparison of patients by KT-2000 test

组别Groups	例数Number of cases	术前Before operation	术后6个月Six months after operation	术后12个月12 months after operation
悬吊组Suspension group	43	8. 93±2. 33	2. 18±0. 24^acd	1. 99±0. 21^ab
袖套组Sleeve group	41	9. 13±1. 86	2. 25±0. 38^ac	2. 01±0. 32^ab
非保残组Debridement group	41	8. 96±1. 97	2. 32±0. 21^a	2. 01±0. 18^ab
F值		3. 762	5. 483	2. 826
P值		>0. 05	0. 016	>0. 05

表4 术后膝关节TTDPM测定本体感觉比较［°，（）］

Table 4 Comparison of proprioception in the measurement of TTDPM among groups

组别Groups	例数Number of cases	6个月Six months	12个月12 months
悬吊组Suspension group	43	3. 69±0. 31^ab	1. 79±0. 22^abc
袖套组Sleeve group	41	4. 05±0. 42^a	2. 05±0. 51^ac
非保残组Debridement group	41	4. 37±0. 28	2. 28±0. 19^c
F值		2. 912	1. 887
P值		0. 011	0. 018

表4 术后膝关节TTDPM测定本体感觉比较［°，（）］

Table 4 Comparison of proprioception in the measurement of TTDPM among groups

组别Groups	例数Number of cases	6个月Six months	12个月12 months
悬吊组Suspension group	43	3. 69±0. 31^ab	1. 79±0. 22^abc
袖套组Sleeve group	41	4. 05±0. 42^a	2. 05±0. 51^ac
非保残组Debridement group	41	4. 37±0. 28	2. 28±0. 19^c
F值		2. 912	1. 887
P值		0. 011	0. 018

表5 术后胫骨隧道扩大情况［°，（）］

Table 5 Comparisons of tibial tunnel enlargement between the three groups

组别Groups	例数Number of cases	3个月Three months	6个月Six months	12个月12 months
悬吊组Suspension group	43	0. 15±0. 12^ab	0. 65±0. 18^abc	0. 81±0. 12^abcd
袖套组Sleeve group	41	0. 22±0. 21^a	0. 75±0. 15^ac	0. 92±0. 17^acd
非保残组Debridement group	41	0. 29±0. 27	0. 92±0. 19^c	1. 17±0. 16^cd
F值		3. 276	4. 051	7. 546
P值		0. 041	0. 029	0. 011

表5 术后胫骨隧道扩大情况［°，（）］

Table 5 Comparisons of tibial tunnel enlargement between the three groups

组别Groups	例数Number of cases	3个月Three months	6个月Six months	12个月12 months
悬吊组Suspension group	43	0. 15±0. 12^ab	0. 65±0. 18^abc	0. 81±0. 12^abcd
袖套组Sleeve group	41	0. 22±0. 21^a	0. 75±0. 15^ac	0. 92±0. 17^acd
非保残组Debridement group	41	0. 29±0. 27	0. 92±0. 19^c	1. 17±0. 16^cd
F值		3. 276	4. 051	7. 546
P值		0. 041	0. 029	0. 011

表6 术后移植物MRI信号强度比较［dBm，（）］

Table 6 Comparisons of postoperative MRI signal intensity of grafts

组别Groups	例数Number of cases	3个月Three months	6个月Six months	12个月12 months	F值	P值
悬吊组Suspension group	43	4. 11±0. 46^ab	2. 46±0. 41^abc	1. 25±0. 16^abcd	2. 722	0. 023
袖套组Sleeve group	41	5. 08±0. 42^a	3. 78±0. 35^ac	2. 67±0. 22^acd	2. 462	0. 031
非保残组Debridement group	41	6. 11±0. 51	4. 55±0. 39^c	2. 99±0. 27^cd	3. 435	0. 016
F值		2. 834	1. 867	2. 285
P值		0. 012	0. 017	0. 015

表6 术后移植物MRI信号强度比较［dBm，（）］

Table 6 Comparisons of postoperative MRI signal intensity of grafts

组别Groups	例数Number of cases	3个月Three months	6个月Six months	12个月12 months	F值	P值
悬吊组Suspension group	43	4. 11±0. 46^ab	2. 46±0. 41^abc	1. 25±0. 16^abcd	2. 722	0. 023
袖套组Sleeve group	41	5. 08±0. 42^a	3. 78±0. 35^ac	2. 67±0. 22^acd	2. 462	0. 031
非保残组Debridement group	41	6. 11±0. 51	4. 55±0. 39^c	2. 99±0. 27^cd	3. 435	0. 016
F值		2. 834	1. 867	2. 285
P值		0. 012	0. 017	0. 015

表7 术后移植物MRI的SNQ比较（）

Table 7 Comparisons of grafts SNQ on MRI after surgery

组别Groups	例数Number of cases	3个月Three months	6个月Six months	12个月12 months	F值	P值
悬吊组Suspension group	43	4. 11±0. 46^ab	2. 46±0. 41^abc	1. 25±0. 16^abcd	4. 255	0. 032
袖套组Sleeve group	41	5. 08±0. 42^a	3. 78±0. 35^ac	2. 67±0. 22^acd	4. 151	0. 035
非保残组Debridement group	41	6. 11±0. 51	4. 55±0. 39^c	2. 99±0. 27^cd	5. 546	0. 021
F值		1. 752	1. 583	0. 854
P值		0. 022	0. 028	0. 031

表7 术后移植物MRI的SNQ比较（）

Table 7 Comparisons of grafts SNQ on MRI after surgery

组别Groups	例数Number of cases	3个月Three months	6个月Six months	12个月12 months	F值	P值
悬吊组Suspension group	43	4. 11±0. 46^ab	2. 46±0. 41^abc	1. 25±0. 16^abcd	4. 255	0. 032
袖套组Sleeve group	41	5. 08±0. 42^a	3. 78±0. 35^ac	2. 67±0. 22^acd	4. 151	0. 035
非保残组Debridement group	41	6. 11±0. 51	4. 55±0. 39^c	2. 99±0. 27^cd	5. 546	0. 021
F值		1. 752	1. 583	0. 854
P值		0. 022	0. 028	0. 031

图7 术后3个月悬吊组矢状位MRI

Figure 7 Sagittal MRI of the suspension group three months after operation

图8 术后3月袖套组矢状位MRI

Figure 8 Sagittal MRI of the sleeve group three months after operation

图9 术后3个月非保残组矢状位MRI 注：红色箭头指原前交叉韧带残端组织存留及覆盖情况Note: The red arrow indicates the retention and coverage of the original anterior cruciate ligament

Figure 9 Sagittal MRI of the debridement group three months after operation

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Comparative analysis of single-bundle reconstruction by different remnant-preserving techniques for anterior cruciate ligament ruptures

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Comparative analysis of single-bundle reconstruction by different remnant-preserving techniques for anterior cruciate ligament ruptures