关节镜下带线锚钉缝合修复前交叉韧带部分损伤的疗效分析

doi:10.3877/cma.j.issn.1674-134X.2023.03.005

目的

探讨关节镜下使用带线锚钉缝合修复前交叉韧带部分损伤的早期疗效。

方法

自2018年1月至2019年12月，共纳入40例就治于昆明医科大学第一附属医院运动医学科的前交叉韧带损伤患者。所有患者为急性损伤且MRI及关节镜下证实前交叉韧带股骨附着处部分撕裂且滑膜覆盖良好，术前查体前抽屉试验或Lachman试验阳性，排除痛风性关节炎及类风湿关节炎病史。其中男25例，女15例；年龄13~42岁，左膝关节患者17例、右膝关节患者23例。关节镜下采用带线锚钉缝合修复部分损伤的膝关节前交叉韧带，MRI检查评价膝关节前交叉韧带修复情况。采用重复测量数据方差分析比较术前及术后3、6、12个月Tegner评分、Lysholm评分、国际膝关节文献委员会膝关节评估表(IKDC)评分。同时招募40例正常膝关节志愿者，利用Opti_Knee膝关节三维运动分析系统采集膝关节运动学数据，采用独立样本t检验比较患者与健康成人的数据、评价患者膝关节功能。

结果

40例患者年龄平均(28.0±1.2)岁，受伤至入院时间平均(13.0±0.4)d。术后均获随访，无前交叉韧带二次损伤，无手术相关并发症。术后12个月患膝Tegner评分、Lysholm评分、IKDC评分与术前比较差异有统计学意义(F＝222.839，295.774，268.836，P<0.05)。MRI结果提示40例患者术后12个月时前交叉韧带走行、信号强度分级均为Ⅰ度。40例患者术后12个月屈伸角度、内外翻角、内外旋转范围、前后、上下和内外位移范围、最大步长、最小步长及步频值与健康人相比差异无统计学意义(P>0.05)。

结论

前交叉韧带部分损伤通过关节镜下带线锚钉缝合修复，有助于术后膝关节早期康复训练及膝关节功能的恢复，早期临床疗效满意。

关键词: 前交叉韧带, 创伤与损伤, 缝合锚, 缝合技术

Objective

To explore the early clinical outcome of partial injury of anterior cruciate ligament (ACL) repair with suture anchor repair under arthroscopy.

Methods

From January 2018 to December 2019, a total of 40 patients with ACL injuries attending the Department of Sports Medicine of the First Affiliated Hospital of Kunming Medical University were included. All the patients were acute injuries and partial tears of the femoral attachment of the ACL with good synovial coverage confirmed by MRI and arthroscopy, with positive results of anterior drawer test or Lachman test before operation. The patients with a history of gouty arthritis or rheumatoid arthritis were exluded. There were 25 males and 15 females, aged from 13 to 42 years. The injured knees were on the left side in 17 patients and on the right side in 23 patients. Under arthroscope, suture anchors were used to repair the partially injured ACL. The recovery of anterior cruciate ligament (ACL) was evaluated by MRI examination. The Tegner score, Lysholm score and IKDC score were compared before surgery and at three, six, 12 months after surgery by repeated measurement data analysis of variance. Forty healthy adults were also recruited for the knee function data by the Opti Knee three-dimensional movement analysis system. The independent sample t test was applied to compare the data of the patients and healthy adults and evaluate the knee function of the patients.

Results

The average age of the patients was (28.0±1.2) years, the time from injury to operation was (13±0.4 )days on average. All the patients were followed up after surgery. There was no secondary ACL injury and operative complications. There were statistically significant differences in Tegner score, Lysholm score and IKDC score at 12 months after operation compared with the data before operation( F=222.839, 295.774, 268.836, all P <0.05). The results of MRI showed that the continuity and fibrosis signal intensity grade of 40 patients were all gradeⅠ. There was no statistically significant difference in the range of internal-external rotation angle, the range of flexion and extension, the range of varus and valgus angles, the ranges of antero-posterior, internal-external and proximal-distal displacements, the maximum step length, the minimum step length or the step frequency compared with healthy adults at 12 months after operation (all P>0.05).

Conclusion

Partial injury of ACL repaired with suture anchor under arthroscope is beneficial to early rehabilitation of knee joint and function recovery of knee, that may achieve good early clinical outcome.

Key words: Anterior cruciate ligament, Wounds and injuries, Suture anchor, Suture techniques

图1 ACL(前交叉韧带)部分损伤关节镜下手术过程。图A示术中探查见ACL股骨附着处撕裂；图B示ACL松弛；图C~D可见ACL表面滑膜覆盖良好；图E在ACL股骨附着撕裂部位植入1枚带缝线可吸收锚钉；图F~G应用缝合钩通过过线技术"8"字缝合ACL；图H示打结固定后探查交叉韧带撕裂端贴附于股骨附着处

Figure 1 Surgical procedure of partial ACL injury under arthroscope. A : intraoperative exploration of ACL femoral attachment tear.; B: ACL relaxation; C~D: the synovial membrane on the surface of ACL was well covered; E: an absorbable anchor with suture was implanted at the femoral attachment tear site of ACL; F~G: suture hooks were used to suture ACL in figure-of-eight suture; H: exploration of the torn end of the cruciate ligaments attached to the femur after fixation

表1 手术组与健康组一般资料

Table 1 General information of the surgical group and healthy group

组别Groups	性别(例，男/女)Gender (male/ female)	年龄[岁，(±s)]Age	侧别(例，左/右)Operation side(left/ right)	BMI[kg/m^2, (±s)]
手术组Operation group	25/15	28.0±1.2	17/23	23.5±1.2
健康组Health group	22/18	28.5±4.9	15/15	23.3±1.0
统计值	χ²＝0.068	t＝1.076	χ²＝0.083	t ＝0.550
P值	>0.05	>0.05	>0.05	>0.05

表1 手术组与健康组一般资料

Table 1 General information of the surgical group and healthy group

组别Groups	性别(例，男/女)Gender (male/ female)	年龄[岁，(±s)]Age	侧别(例，左/右)Operation side(left/ right)	BMI[kg/m^2, (±s)]
手术组Operation group	25/15	28.0±1.2	17/23	23.5±1.2
健康组Health group	22/18	28.5±4.9	15/15	23.3±1.0
统计值	χ²＝0.068	t＝1.076	χ²＝0.083	t ＝0.550
P值	>0.05	>0.05	>0.05	>0.05

表2 患膝手术前后Tegner、Lyshlom及IKDC评分比较[ n＝40，(±s)]

Table 2 Tegner, Lyshlom and IKDC scores of the involved knees before and after knee surgery

时间Time	Tegner	Lyshlom	IKDC
术前Before operation	2.3±0.6	51.9±9.0	48.4±11.8
术后3个月Three months after operation	3.9±0.5^a	76.5±7.0^a	60.7±9.9^a
术后6个月Six months after operation	5.7±0.6^ab	92.6±3.4^ab	89.6±9.1^ab
术后12个月12 months after operation	6.1±0.6^abc	95.8±2.6^abc	96.4±3.7^abc
F值	222.839	295.774	268.836
P值	<0.001	<0.001	<0.001

表2 患膝手术前后Tegner、Lyshlom及IKDC评分比较[ n＝40，(±s)]

Table 2 Tegner, Lyshlom and IKDC scores of the involved knees before and after knee surgery

时间Time	Tegner	Lyshlom	IKDC
术前Before operation	2.3±0.6	51.9±9.0	48.4±11.8
术后3个月Three months after operation	3.9±0.5^a	76.5±7.0^a	60.7±9.9^a
术后6个月Six months after operation	5.7±0.6^ab	92.6±3.4^ab	89.6±9.1^ab
术后12个月12 months after operation	6.1±0.6^abc	95.8±2.6^abc	96.4±3.7^abc
F值	222.839	295.774	268.836
P值	<0.001	<0.001	<0.001

图2 左膝ACL(前交叉韧带)术前术后MRI变化。图A为术前膝关节MRI，示前交叉韧带中夹杂大量高信号，提示损伤；图B为术后6 d膝关节MRI，示前交叉韧带走行连续，其中夹杂部分提示水肿的高信号影；图C为术后6个月膝关节MRI，示前交叉韧带走行良好，连续性较好；图D为术后12个月膝关节MRI，示前交叉韧带走行连续注：无损伤的ACL表现为条状低信号，高信号提示前交叉韧带有损伤，信号越高说明损伤程度越严重

Figure 2 Preoperative and postoperative MRI changes of the ACL of the left knee. A is preoperative MRI, showing a large number of high signals in the anterior cruciate ligament；B is MRI at six days after surgery, showing ACL running continuously with some high-signal shadows; C is MRI at six months after surgery, showing good alignment and continuity of ACL; D is MRI at 12 months after surgery, showing that ACL runs continuouslyNote: the ACL without injury presents as a strip of low signal, high signal indicates the ACL injury, the higher the signal indicates the more serious the injury

表3 患膝术后12个月屈伸角、内外翻角、内外旋角范围[°，(±s)]

Table 3 Comparison of flexion and extension Angle, varus and valgus Angle, internal and external rotation Angle of the affected knee with healthy subjects 12 months after operation

组别Groups	例数Number of cases	屈伸角Flexion and extension	内外翻角Varus and valgus angles	内外旋角Internal and external rotation angles
手术组Operation group	40	56.0±4.2	11.9±2.1	13.4±2.4
健康组Health group	40	56.9±5.0	12.5±2.9	13.7±2.7
t值		0.756	0.899	0.474
P值		>0.05	>0.05	>0.05

表3 患膝术后12个月屈伸角、内外翻角、内外旋角范围[°，(±s)]

Table 3 Comparison of flexion and extension Angle, varus and valgus Angle, internal and external rotation Angle of the affected knee with healthy subjects 12 months after operation

组别Groups	例数Number of cases	屈伸角Flexion and extension	内外翻角Varus and valgus angles	内外旋角Internal and external rotation angles
手术组Operation group	40	56.0±4.2	11.9±2.1	13.4±2.4
健康组Health group	40	56.9±5.0	12.5±2.9	13.7±2.7
t值		0.756	0.899	0.474
P值		>0.05	>0.05	>0.05

表4 患膝术后12月的前后、上下、内外位移范围[cm，(±s)]

Table 4 Anteroposterior, proximal-distal and internal-external displacements of the involved knee at 12 months after operation

组别Groups	例数Number of cases	前后位移Antero-posterior displacement	上下位移Proximal-distal displacement	内外位移Iinternal-external displacement
手术组Operation group	40	1.50±0.36	1.45±0.32	0.86±0.25
健康组Health group	40	1.49±0.39	1.38±0.34	0.85±0.25
t值		0.127	0.86	0.041
P值		>0.05	>0.05	>0.05

表4 患膝术后12月的前后、上下、内外位移范围[cm，(±s)]

Table 4 Anteroposterior, proximal-distal and internal-external displacements of the involved knee at 12 months after operation

组别Groups	例数Number of cases	前后位移Antero-posterior displacement	上下位移Proximal-distal displacement	内外位移Iinternal-external displacement
手术组Operation group	40	1.50±0.36	1.45±0.32	0.86±0.25
健康组Health group	40	1.49±0.39	1.38±0.34	0.85±0.25
t值		0.127	0.86	0.041
P值		>0.05	>0.05	>0.05

表5 术后12个月患膝最大、最小步长及步频值(±s)

Table 5 Maximum and minimum stride lengths and stride frequency of the involved knee at 12 months after operation

组别Groups	例数Number of cases	最大步长(cm)Maximum step length	最小步长(cm)Minimum step length	步频(步/min)Step frequency
手术组Operation group	40	51.3±3.6	45.1±4.1	12.4±1.1
健康组Health group	40	51.2±3.9	45.1±4.1	12.8±1.2
t值		0.174	0.07	1.372
P值		>0.05	>0.05	>0.05

表5 术后12个月患膝最大、最小步长及步频值(±s)

Table 5 Maximum and minimum stride lengths and stride frequency of the involved knee at 12 months after operation

组别Groups	例数Number of cases	最大步长(cm)Maximum step length	最小步长(cm)Minimum step length	步频(步/min)Step frequency
手术组Operation group	40	51.3±3.6	45.1±4.1	12.4±1.1
健康组Health group	40	51.2±3.9	45.1±4.1	12.8±1.2
t值		0.174	0.07	1.372
P值		>0.05	>0.05	>0.05

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Clinical outcome of anterior cruciate ligament partial injury repair with suture anchor under arthroscopy

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Clinical outcome of anterior cruciate ligament partial injury repair with suture anchor under arthroscopy