【摘要】 目的 探讨关节镜下前交叉韧带重建术中保留残端与否以及保留残端长度对临床疗效的影响。方法 前瞻性研究2019年5月—2020年1月大连市第二人民医院微创关节二科收治的140例新鲜前交叉韧带断裂患者。男性83例，女性57例；年龄18～50岁，平均37.0岁；致伤原因：运动伤109例，道路交通伤24例，其他7例。患者均接受关节镜下前交叉韧带重建手术，根据前交叉韧带残端处理方式的不同分为A、B、C、D组，每组各35例。A组完全切除残端重建，B组重建后残端覆盖长度<原有残端覆盖长度的3/10,C组重建后残端覆盖长度为原有残端覆盖长度的3/10～6/10,D组重建后残端覆盖长度>原有残端覆盖长度的6/10。术后定期随访12个月，比较4组患者膝关节功能、膝关节稳定性、本体感觉功能以及胫骨骨道直径增加程度。结果 4组术后国际膝关节文献委员会（international knee documentation committee,IKDC）评分、Lysholm评分、KT-2000评分以及胫骨骨道直径增加差值均逐渐增大（P<0.05）,4组术后屈曲15°、45°、75°关节位置感觉测定值（joint position sense,JPS）逐渐降低（P<0.05）。B、C、D组术后1、3、6、12个月IKDC评分、Lysholm评分、KT-2000评分均高于A组（P<0.05）,3组组间比较差异无统计学意义（P>0.05）。D组术后1、3、6、12个月屈曲15°、45°、75°JPS小于A、B、C组（P<0.05），且C组小于B组和A组（P<0.05）,B组小于A组（P<0.05）;D组术后1、3、6、12个月胫骨骨道直径增加差值小于A、B、C组（P<0.05），且C组小于A组和B组（P<0.05）,B组小于A组（P<0.05）;4组间并发症发生率比较差异无统计学意义（P> 0.05）。结论 相较于不保留残端，保留残端前交叉韧带重建的术后膝关节功能、膝关节稳定性、本体感觉恢复效果更佳，并能降低骨道扩大风险，保留6/10的残端在本体感觉恢复以及降低骨道扩大风险方面更具优势。更多还原

【Abstract】 Objective To investigate the clinical effect of whether reserving anterior cruciate ligament(ACL) remnant and the suitable length during arthroscopic ACL reconstruction after rupture.Methods A total of140 fresh ACL ruptures admitted to our hospital from May 2019 to Jan. 2020 were selected prospectively. There were 83 males and 57 females,aged from 18 to 50 years,mean 37. 0 years. The injury mechanisms were as follows:109 sports injuries,24 road traffic crashes and 7 others. All patients underwent arthroscopic ACL reconstruction.According to whether the remnant was preserved and its length,patients were divided into 4 groups with 35 patients each. In group A,the residual ligament was completely removed during reconstruction,while in groups A-D,the remnant was preserved with the length being respectively < 3/10,3/10-6/10 and > 6/10 of the original coverage length. Patients were followed up regularly for 12 months. The knee function,knee stability,proprioceptive function and enlargement of the tibial bone tunnel diameters were compared among groups.Results The International Knee Documentation Committee(IKDC) score,Lysholm score,KT-2000 score and enlargement of the tibial bone tunnel diameters were gradually increased in the four groups(allP< 0. 05),and the joint position sense(JPS) at the postoperative flexion of 15°,45° and 75° were gradually decreased(P< 0. 05). At 1,3,6 and 12 months after surgery,the IKDC score,Lysholm score and KT-2000 score in groups B-D were much higher than those in group A(P< 0.05),but no significant difference was found among groups B-D(P> 0. 05); while the JPS at 15°,45° and 75°flexion and enlargement of the tibial bone tunnel diameters showed similar decrease tread: group D < group C <group B < group A(P< 0. 05 between any two groups). However,there was no significant difference regarding the incidence of complications among all the four groups(P> 0. 05).Conclusion Compared with removal,reserving ACL remnant showed better effects on postoperative knee function/stability and proprioceptive recovery,and moreover can reduce the risk of bone tunnel enlargement. Retaining more than 6/10 of the remnant is superior in terms of proprioceptive recovery and reducing the risk of bone tunnel enlargement.更多还原