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  • Tight Rope微型钢板联合自体腘绳肌腱移植治疗前交叉韧带损伤的临床效果

Tight Rope微型钢板联合自体腘绳肌腱移植治疗前交叉韧带损伤的临床效果

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  [摘要]目的 探討Tight Rope微型钢板联合自体腘绳肌腱移植治疗前交叉韧带损伤的临床效果。方法 选取2017年8月~2018年8月我院收治的68例前交叉韧带损伤患者作为研究对象,按照随机数字表法分为对照组(34例)和研究组(34例)。对照组应用前交叉韧带单束重建手术治疗,研究组应用Tight Rope微型钢板联合自体腘绳肌腱移植治疗。比较两组的日本矫形外科学会(JOA)评分、Lysholm评分及治疗效果。结果 研究组的疼痛、行走功能、稳定性评分高于对照组,差异均有统计学意义(P<0.05);研究组的跛行、承受能力、上下楼能力、关节肿痛、下蹲起立评分高于对照组,差异均有统计学意义(P<0.05);研究组的治疗总有效率显著高于对照组,差异有统计学意义(P<0.05)。结论 Tight Rope微型钢板联合自体腘绳肌腱移植治疗前交叉韧带损伤能提升术后膝关节的活动功能和治疗效果,值得临床推广应用。
  [关键词] Tight Rope微型钢板;自体腘绳肌腱移植;前交叉韧带损伤
  [中图分类号] R686          [文献标识码] A          [文章编号] 1674-4721(2019)11(a)-0113-03
  Clinical effect of tight Rope miniplate combined with autogenous hamstring tendon transplantation in the treatment of anterior cruciate ligament injury
  ZHOU Yu   KANG Zhao-he   ZHOU Gang
  Department of Orthopedics, Ji′an Hospital, Shanghai Oriental Hospital, Jiangxi Province, Ji′an   343000, China
  [Abstract] Objective To investigate the clinical effect of tight Rope miniplate combined with autogenous hamstring tendon transplantation in the treatment of anterior cruciate ligament injury. Methods A total of 68 patients with ACL injury admitted to our hospital from August 2017 to August 2018 were selected as the study objects, which were divided into control group (34 cases) and study group (34 cases) according to the random number table method. The control group was treated with single bundle reconstruction of anterior cruciate ligament, and the study group was treated with tight rope mini plate and autogenous hamstring tendon transplantation. The JOA score, Lysholm score and therapeutic effect of the two groups were compared. Results The scores of pain, walking function and stability in the study group were higher than those in the control group, the differences were statistically significant (P<0.05). The scores of limp, bearing capacity, ability of going up and down stairs, joint swelling and pain, squatting and standing up in the study group were higher than those in the control group, the differences were statistically significant (P<0.05). The total effective rate of the study group was significantly higher than that of the control group, the difference was statistically significant (P<0.05). Conclusion Tight Rope microplate combined with autologous hamstring tendon transplantation for the treatment of anterior cruciate ligament injury can improve the activity and treatment of knee joint after operation, which is worthy of clinical application.   ACL单束重建往往应用4股腘绳肌腱,也有报道应用双束8股腘绳进行肌腱重建,其重建效果ACL要优于4股重建[13]。借助于加大移植物股数,有利于强化ACL重建后移植物强度。带袢钢板固定是弹性固定的一种,术后早期易发生位移,移植物在患者进行膝关节活动的时候,易沿着骨隧道的长轴方向发生移动,从而使袢以及移植物松弛。为防止这种问题发生,确保移植物股骨端牢固,需要在手术过程中确保移植物同骨隧道的直径较为匹配,实现移植物以及隧道间的密切接触[14]。为避免术后袢的松弛,应当在手术过程中引导移植物进入隧道,拉出钢板到股骨髁外侧后,手术医师需要两手用力收紧袢环线,确保钢板及袢环两侧强度均衡。在收紧袢环线的过程中需要保证钢板紧贴骨皮质,因此手术过程中需要实现X线透视,发现钢板位置不够理想的问题,需要改变收紧线的方向加以校正[15]。本研究结果提示,研究组的疼痛、行走功能、稳定性评分高于对照组,差异有均统计学意义(P<0.05);研究组的跛行、承受能力、上下楼能力、关节肿痛、下蹲起立评分高于对照组,差异均有统计学意义(P<0.05),提示患者的膝关节功能恢复理想,无明显的膝关节松弛问题。不过需要注意的是,本研究的研究样本较少同时随访时间较短,未进行独臂研究,远期疗效需要后续随访追踪。
  综上所述,Tight Rope微型钢板联合自体腘绳肌腱移植治疗ACL损伤能提升术后膝关节的活动功能和治疗效果,值得临床推广应用。
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  (收稿日期:2019-04-12 本文编辑:刘克明)
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