目的:比较韧带高级加固系统(LARS)和自体绳肌腱加高强度缝合在关节镜下重建后交叉韧带(PCL)中的临床疗效。
方法:选取2019年8月至2021年12月我院收治的单纯PCL损伤患者96例,行关节镜下后交叉韧带重建手术进行完整随访。有78名男性和18名女性,左腿40例,右腿56例,年龄20~56岁,平均(32.50±8.68)岁。将其分为两组:LARS组(52例)和自体绳肌腱加高强度缝合组(44例)。在LARS组中,男性42例,女性10例;平均年龄(31.84±8.62)岁;体重指数(BMI)为(24.73±2.29)kg·m-2;7mmLARS用于重建PCL。在自体肌腱组中,有36名男性和8名女性,平均年龄(33.06±8.99)岁,BMI为(23.52±2.16)kg·m-2,用四股绳肌腱和三片埃塞俄比亚键缝线重建PCL。所有患者均进行功能康复指导锻炼,术后定期随访,通过KT-1000测量膝关节松弛度客观评价膝关节稳定性,并通过Lysholm评分对膝关节功能进行主观评价,Tegner得分,和国际膝关节文献委员会(IKDC)评分。术前数据,收集随访3、6、12个月,采用SPSS软件进行分析,比较两组患者术后恢复及韧带松弛情况。
结果:96例患者随访12个月。自体肌腱组和LARS组术前膝关节KT-1000测量[(10.73±1.46)分vs(10.55±1.53)分],术后6个月[(3.02±0.75)分vs(2.35±0.60)分],术后12个月[(3.77±1.76)分vs(2.44±0.60)分]。术后6、12个月两组比较差异有统计学意义(P<0.05)。术后3个月两组比较差异无统计学意义(P>0.05)。在自体肌腱组和LARS组中,手术前和手术后12个月,Lysholm总分[(40.6±16.8),(91.25±6.35)点vs(51.92±18.52),(92.35±5.30)分],Tegner评分[(1.8±0.7),(5.8±0.6)分vs(1.7±0.8),(5.7±0.7)分]和IKDC总分[(54.50±6.33),(83.90±3.93)点vs(54.40±4.24),(83.62±3.64)分],差异有统计学意义(P<0.05),提示两组患者术后膝关节功能均有改善。自体肌腱组和LARS组术后3、6个月,Lysholm总分[(65.86±11.54),(74.60±6.46)点vs(73.46±6.42),(86.73±4.62)分],Tegner评分[(2.5±0.6),(3.5±0.5)点vs(4.3±0.7),(5.0±1.4)分],IKDC总分[(55.78±2.68),(70.62±4.74)点vs(65.31±4.60),(79.71±2.93)分]。两组比较差异有统计学意义(P<0.05)。结果表明,LARS组膝关节功能优于自体肌腱组。然而,手术后12个月,两组膝关节功能评分比较,差异无统计学意义(P>0.05)。结果表明,LARS组的稳定性优于自体肌腱组。
结论:自体绳肌腱加高强度缝合和LARS重建术均能明显改善膝关节功能和稳定性,术后效果满意。HowervrLARS提供优越的术后稳定性。
OBJECTIVE: To compare the clinical efficacy of ligament advanced reinforcement system (LARS) and autogenous hamstring tendon plus high-strength suture in arthroscopic reconstruction of posterior cruciate ligament(PCL).
METHODS: A total of 96 patients with simple PCL injury treated with arthroscopic posterior cruciate ligament reconstructive surgery admitted to our hospital between August 2019 and December 2021 were selected for complete follow-up. There were 78 males and 18 females, 40 cases of left leg and 56 cases of right leg, the aged from 20 to 56 years old with an average of (32.50±8.68 ) years old. The transplants were divided into two groups:LARS group (52 cases) and autogenous hamstring tendon plus high-strength suture group (44 cases). In the LARS group, there were 42 males and 10 females;with an average age of (31.84±8.62) years old;body mass index (BMI) was (24.73±2.29) kg﹒m-2;7 mm LARS was used to reconstruct PCL. In the autologous tendon group, there were 36 males and 8 females, with an average age of (33.06±8.99) years old, BMI was (23.52±2.16) kg·m-2, and the PCL was reconstructed with four strands of hamstring tendons and three pieces of Ethibond suture. All patients underwent functional rehabilitation guided exercise and were followed up regularly after surgery to objectively evaluate the stability of the knee joint by KT-1000 measurement of knee relaxation, and subjective evaluation of knee function by Lysholm score, Tegner score, and International Knee Documentation Council (IKDC) score. Data from preoperative, 3, 6, and 12 month follow-up were collected and analyzed by SPSS software to compare postoperative recovery and ligament relaxation between the two groups of patients.
RESULTS: Ninety-six patients were followed up for 12 months. KT-1000 measurement of knee joint in autogenous tendon group and LARS group before operation [(10.73±1.46) points vs (10.55±1.53) points], 6 months after operation[(3.02±0.75) points vs (2.35±0.60) points], 12 months after operation[(3.77±1.76) points vs (2.44±0.60) points]. There was significant difference between the two groups at 6 and 12 months after operation (P<0.05), but there was no significant difference between the two groups at 3 months after operation (P>0.05). In the autogenous tendon group and LARS group, before operation and 12 months after operation, total Lysholm score [(40.6±16.8), (91.25±6.35) points vs (51.92±18.52), (92.35±5.30) points], Tegner score[(1.8±0.7), (5.8±0.6) points vs(1.7±0.8)、(5.7±0.7) points] and total IKDC score[(54.50±6.33), (83.90±3.93) points vs (54.40±4.24), (83.62±3.64) points], the differences were statistically significant (P<0.05), indicating that the knee function of the two groups was improved after surgery. At 3 and 6 months after operation in the autogenous tendon group and LARS group, the total Lysholm score[(65.86±11.54), (74.60±6.46) points vs (73.46±6.42), (86.73±4.62) points], Tegner score[(2.5±0.6), (3.5±0.5) points vs (4.3±0.7), (5.0±1.4) points], the total scores of IKDC [(55.78±2.68), (70.62±4.74) points vs (65.31±4.60), (79.71±2.93) points]. The difference between two groups was statistically significant (P<0.05). The results showed that the function of the knee joint in the LARS group was better than that the autologous tendon group. However, at 12 months after the operation, there was no significant difference in the score of knee joint function between the two groups (P>0.05). The results showed that the stability of LARS group was better than that of autologous tendon group.
CONCLUSIONS: Both the autogenous hamstring tendon plus high-strength suture and LARS reconstruction can significantly improve the knee function and stability, with satisfactory postoperative results. Howervr the LARS provides superior postoperative stability.