改良Le-maire前外侧肌腱固定联合单束重建术对伴高度轴移的前交叉韧带损伤患者的疗效观察

Efficacy of modified Le-maire anterolateral tenodesis combined with single-bundle reconstruction in the treatment of anterior cruciate ligament injury with high axial shift

摘要:

目的 观察改良Le-maire前外侧肌腱固定联合单束重建术对伴高度轴移的前交叉韧带（ACL）损伤患者的疗效。方法 选取2020年10月—2023年3月中国人民解放军联勤保障部队第九八三医院收治的108例伴高度轴移的ACL损伤患者作为研究对象。根据手术方案分为两组：接受改良Le-maire前外侧肌腱固定联合单束重建术的54例患者纳入联合组，接受单纯单束重建术的54例患者纳入单纯重建组。比较两组膝关节稳定性（膝关节轴移试验、KT-2000侧间差）、膝关节功能［Lysholm膝关节评分量表、国际膝关节文献委员会（IKDC）主观评分表］、末次随访时重返运动情况（重返伤前运动水平、重返运动时间、Tegner评分）及并发症发生情况。结果 联合组末次随访时轴移试验分级低于单纯重建组（P <0.05）；联合组末次随访时KT-2000侧间差低于单纯重建组（P <0.05）。联合组末次随访时Lysholm膝关节评分、IKDC主观评分均高于单纯重建组（P <0.05）。联合组末次随访时重返伤前运动水平占比和Tegner评分均高于单纯重建组，重返运动时间短于单纯重建组（P <0.05）。联合组与单纯重建组并发症总发生率比较，差异无统计学意义（P >0.05）。结论 与单纯重建术比较，改良Le-maire前外侧肌腱固定联合单束重建术对伴高度轴移的ACL损伤患者疗效更好，可有效地恢复膝关节稳定性与功能，更早、更好地重返运动，且未增加术后并发症风险。

Abstract:

Objective To evaluate the efficacy of modified Le-maire anterolateral tenodesis combined with single-bundle reconstruction in patients with anterior cruciate ligament (ACL) injuries accompanied by high axial shift.Methods A total of 108 patients with ACL injuries accompanied by high axial shift, admitted to the 983rd Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army between October 2020 and March 2023, were included in the study. Patients were divided into two groups based on the surgical approach: 54 patients who underwent modified Le-maire anterolateral tenodesis combined with single-bundle reconstruction were included in the combined group, while 54 patients who underwent single-bundle reconstruction alone were included in the simple reconstruction group. Knee stability (knee axial shift test, KT-2000 side-to-side difference), knee function [Lysholm Knee Score, International Knee Documentation Committee (IKDC) subjective score], return to sport at the final follow-up (return to pre-injury activity level, time to return to sport, Tegner score), and incidence of complications were compared between the two groups.Results At the final follow-up, the combined group had a lower grade on the axial shift test than the simple reconstruction group (P < 0.05); the combined group also had a lower KT-2000 side-to-side difference at the final follow-up than the simple reconstruction group (P < 0.05). At the final follow-up, both the Lysholm Knee Score and the IKDC subjective score were higher in the combined group than in the simple reconstruction group (P < 0.05). At the final follow-up, the proportion of patients in the combined group who had returned to their pre-injury level of activity and their Tegner score were both higher than those in the simple reconstruction group, and the time to return to sport was shorter than in the simple reconstruction group (P < 0.05). There was no statistically significant difference in the overall incidence of complications between the combined group and the simple reconstruction group (P > 0.05).Conclusion Compared with isolated reconstruction, modified Le-maire anterolateral tenodesis combined with single-bundle reconstruction yields better outcomes for patients with ACL injuries accompanied by significant axial shift. This approach effectively restores knee stability and function, enables earlier and better return to sport, and does not increase the risk of postoperative complications.