微创后内侧取腱结合"全内"技术在老年膝前交叉韧带重建中的应用

Application of minimally invasive semitendinosus tendon extraction combined with"all-inside"technique to reconstruct anteri-or cruciate ligament in elderly patients

中文关键词: 老年  前交叉韧带重建  半腱肌肌腱  膝关节镜  "全内"技术

英文关键词: elderly  anterior cruciate ligament reconstruction  semitendinosus tendon  knee arthroscopy  "all-inside"technique

中文摘要:

      目的 探讨微创后内侧取腱结合"全内(All-inside)"重建技术治疗老年患者膝关节前交叉韧带(Anterior cruci-ate ligament,ACL)损伤的临床结果,为老年ACL重建提供更好的手术方式.方法 回顾性分析2021 年6 月—2022 年8月宁波市第九医院收治的50 例老年ACL损伤患者的临床资料,根据不同的手术方式分为观察组(n =26)和对照组(n = 24).观察组采用微创后内侧切口取半腱肌肌腱,股骨和胫骨侧均使用TightRope可调节袢钢板固定的"全内"技术重建ACL;对照组采用传统前内侧切口鹅足部位取半腱肌肌腱+股薄肌肌腱,股骨侧使用Endobutton固定、胫骨侧使用界面挤压螺钉固定的传统技术重建ACL.观察并比较2 组术中取腱切口长度、手术时间、胫骨隧道粗骨道长度(胫骨骨道丢失骨量)、术后VAS评分、最大屈曲角度及术后并发症发生情况;于术前后比较 2 组患者Tegner评分、IKDC评分及Lysholm评分;综合评价2 组临床结果.结果 术后50 例患者均获得随访,时间12～18 个月,平均(14.6±1.9)个月.观察组术中取腱切口长度、手术时间及胫骨骨道丢失骨量均少于对照组(P＜0.05);观察组术后 1 个月内各时间点VAS评分均低于对照组(P＜0.05);2 组术后1 年时膝关节最大屈曲角度差异无统计学意义(P＞0.05);2 组术后Tegner评分、IKDC评分及Lysholm评分均高于同组术前(P＜0.05),但 2 组患者术后Tegner评分、IKDC评分及Lysholm评分差异均无统计学意义(P＞0.05);2 组术后均未出现关节感染、隐神经损伤等并发症.结论 采用微创后内侧取腱结合"全内"技术重建老年ACL的手术方式,可能具有更微创、骨量丢失少及操作更简单的优势,术后可获得较好的临床结果,比传统术式具有一定的优势.

英文摘要:

      Objective To explore the clinical results of minimally invasive semitendinosus tendon extraction combined with"all-inside"reconstruction technique for the treatment of anterior cruciate ligament(ACL)injury in elderly patients,so as to provide a better surgical method for ACL reconstruction in elderly patients.Methods The clinical data of 50 elderly patients with ACL injury admitted to Ninth Hospital of Ningbo City from June 2021 to August 2022 were retrospectively analyzed.They were divided into observation group(n =26)and control group(n =24)according to different surgical methods.In the obser-vation group,a minimally invasive posteromedial incision was performed to extract the semitendinosus tendon,and the"all-in-side"technique was used to reconstruct the ACL by TightRope adjustable loop plate fixation on both femur and tibia.In the control group,the traditional anteromedial incision was performed to extract the semitendinosus tendon and gracilis tendon from the goose foot area,and the ACL was reconstructed with Endobutton fixation on the femoral side and interfacial extrusion screw fixation on the tibia side.The length of tendon incision,operation time,length of rough bone canal in the tibial tunnel(bone loss of tibial tunnel),postoperative VAS score,maximal flexion angle and postoperative complications were observed and com-pared between the two groups.Tegner score,IKDC score and Lysholm score were compared between the two groups before and after surgery.The clinical results of the two groups were evaluated comprehensively.Results All 50 patients were followed up for 12 to 18 monthsmean(14.6±1.9)months.The length of tendon incision,operation time,and bone lossof tibial tunnel in the observation group were all less than those in the control group(P＜0.05).Within one month after surgery,the VAS scores of the observation group were lower than those of the control group at each time point(P＜0.05).There was no significant difference in the maximal knee flexion angle between the two groups at 1 year after surgery(P＞0.05).The postoperative Tegner score,IKDC score,and Lysholm score of the two groups were higher than those of the same group before surgery(P＜0.05),but there was no statistically significant difference between the two groups(P＞0.05).No postoperative complica-tions,such as joint infection,saphenous nerve injury and etc.,occurred in both groups.Conclusion The surgical method of minimally invasive semitendinosus tendon extraction combined with"all-inside"technique for ACL reconstruction in the elderly may have the advantages of more minimally invasive,less bone loss and simpler operation.It can achieve better clinical results after surgery and has certain advantages over traditional surgical methods.