| 符梓源,陈宏.移植物种类对前交叉韧带重建患者术后早期重返运动的影响研究[J].浙江中西医结合杂志,2025,35(12): |
| 移植物种类对前交叉韧带重建患者术后早期重返运动的影响研究 |
| Effect of graft types on early return to sport of patients after anterior cruciate ligament reconstruction |
| 投稿时间：2025-02-22 修订日期：2025-11-18 |
| DOI： |
| 中文关键词: 前交叉韧带 腓骨长肌腱 腘绳肌肌腱 人工韧带 重返运动 |
| 英文关键词:anterior cruciate ligament peroneus longus tendon hamstring tendon artificial ligament return to sports |
| 基金项目: |
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| 中文摘要: |
| 背景：重建前交叉韧带（Anterior Cruciate Ligament，ACL）后患者术后早期重返运动（Return To Sport，RTS）与手术方式、移植物性质等多种因素有关，目前评估患者RTS时机的标准尚未达成一致。目的：探究关节镜下应用自体腘绳肌腱（hamstring tendon，HT）或自体腘绳肌腱+腓骨长肌腱（Peroneus longus tendon，PLT）或自体腘绳肌腱+人工韧带（ligament advanced reinforcement system，LARS，法国拉思公司）重建膝关节ACL的临床疗效，并对术后膝关节早期功能及重返运动情况进行分析。方法：回顾性分析本院骨科中心 2020 年 9 月至2023年 9 月收治的 132 例ACL断裂患者的一般资料，根据术中采用移植物种类将所有患者分成3组，分别为HT组（A组，32 例），PLT组（B组，63例），LARS组（C组，37例）行关节镜下单束重建ACL。所有患者均确认ACL断裂。患者手术前后分别采用等速肌力测试方法计算两侧肌力肢体对称性指数（Limb Symmetry Index，LSI）和患肢腘绳肌与股四头肌比值（Hamstring-Quadriceps Ratio，H/Q）,国际膝关节文献委员会（International Knee Documentation Committee，IKDC）评分评价膝关节功能，ACL损伤后恢复运动?（Anterior Cruciate Ligament Return to Sport after Injury，ACL-RSI）量表评价运动心理状况及水平；踝关节足踝残疾指数（Foot and Ankle Disability Index，FADI）评分评价足踝功能。结果：132例患者术后均获随访，平均12±1.3个月，无关节感染、膝关节僵硬、韧带再断裂等并发症。编织后移植物直径B、C组大于A组，但差异无统计学意义（P>0.05）。3组患者术后LSI,H/Q,IKDC评分，ACL-RSI量表评分及FADI评分均较术前改善（P<0.05），其中LSI,H/Q,IKDC评分，ACL-RSI评分在第6个月时，B、C组较A组较高，具有统计学差异（P<0.05），其余时间三组之间差异不明显（P>0.05）。
结论：关节镜下应用腘绳肌腱+腓骨长肌腱重建ACL术后早期重返运动表现良好，且无明显踝关节功能受限，可适用于年轻ACL损伤患者。 |
| 英文摘要: |
| Background: Early return to sport (RTS) after reconstruction of the anterior cruciate ligament (ACL) is related to multiple factors such as the surgical method and the nature of the graft. Currently, the criteria for evaluating the timing of RTS in patients have not yet been agreed.
Objective: To explore the clinical efficacy of arthroscopic knee ACL reconstruction with autologous hamstring tendon (HT), autologous hamstring tendon combined with peroneus longus tendon (PLT), or autologous hamstring tendon combined with artificial ligament (Ligament Advanced Reinforcement System, LARS, France) in patients with ACL injuries. Additionally, to analyze the early function of the knee joint and return to movement after surgery.
Methods: A retrospective analysis was conducted on 132 patients with ACL rupture treated at our orthopedic center from September 2020 to September 2023. Patients were divided into three groups based on the type of graft used during surgery: HT group (Group A, 32 cases), PLT group (Group B, 63 cases), and LARS group (Group C, 37 cases). All patients underwent arthroscopic single-bundle ACL reconstruction. Pre- and postoperative assessments included the calculation of the Limb Symmetry Index (LSI) and Hamstring-Quadriceps Ratio (H/Q) using isokinetic strength testing, International Knee Documentation Committee (IKDC) score for knee function, Anterior Cruciate Ligament Return to Sport after Injury (ACL-RSI) scale for psychological readiness and sports level, and Foot and Ankle Disability Index (FADI) score for ankle function.
Results: The general data of 132 patients with ACL rupture admitted to the Orthopedic Center of our hospital from September 2020 to September 2023 were retrospectively analyzed. All patients were divided into 3 groups according to the type of grafts used during the operation, namely HT Group (Group A, 32 cases), PLT Group (Group B, 63 cases), and LARS Group (Group C, 37 cases) underwent arthroscopic single-bundle ACL reconstruction. ACL fractures were confirmed in all patients. Before and after surgery, the patient's isokinetic muscle strength test was used to calculate the Limb Symmetry Index (LSI) and the Hamstring-Quadriceps Ratio (H/Q) of the affected limb. The International Knee Documentation Committee (IKDC) score was used to evaluate knee joint function. The Anterior Cruciate Ligament Return to Sport after Injury (ACL-RSI) scale was used to evaluate exercise psychological status and level; the Foot and Ankle Disability Index (FADI) score was used to evaluate foot and ankle function.?.
Conclusion: Arthroscopic ACL reconstruction with hamstring tendon + peroneus longus tendon performs well in early re-movement without significant ankle joint function limitation, and can be suitable for young patients with ACL injury |
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