不同手术时机对前交叉韧带伴半月板损伤膝关节镜手术治疗效果的影响

    Effect of different operation timing on knee arthroscopic treatment effect of anterior cruciate ligament with meniscus injury

    • 摘要:
      目的  分析前交叉韧带(ACL)伴半月板损伤不同膝关节镜手术时机对治疗效果的影响。
      方法  回顾性分析接受膝关节镜手术的86例ACL伴半月板损伤病人临床资料,按不同膝关节镜手术时机分为早期组(41例,受伤至手术时间≤3周)、晚期组(45例,受伤至手术时间>3周)。术后6个月,对比2组骨通道恢复情况、膝关节功能、疼痛程度、稳定性应力、膝关节液SDF-1/CXCR4通路相关因子含量及并发症。
      结果  早期组术后6个月信号强度、骨髓道宽度、腱骨结点T2值均比晚期组低(P <0.01);早期组术后6个月IKDC评分、Lysholm评分、膝关节活动度比晚期组高,VAS评分比晚期组低(P <0.01);早期组术后6个月应力位下外侧间室撑开距离、应力位下胫骨后移距离、屈膝30°及90°拨号试验胫骨外旋角度比晚期组低(P <0.01);早期组术后6个月膝关节液SDF-1、CXCR4、MMP-3及MMP-13水平比晚期组低(P <0.01);早期组并发症发生率(4.88%)比晚期组(20.00%)低(P <0.05)。
      结论  与晚期膝关节镜手术相比,早期膝关节镜手术能加快ACL伴半月板损伤病人的骨通道恢复,提高膝关节功能与膝关节活动度,降低疼痛程度,改善稳定性应力,抑制SDF-1/CXCR4信号通路表达,进而降低软骨损伤等并发症的发生率。

       

      Abstract:
      Objective To analysis of the influence of different surgery timing on the knee arthroscopic treatment effect of anterior cruciate ligament (ACL) with meniscus injury.
      Methods The clinical data of 86 patients with ACL associated with meniscus injury who underwent arthroscopic knee surgery were retrospectively analyzed. According to the different timing of arthroscopic knee surgery, they were divided into the early group (41 cases, the time from injury to surgery ≤3 weeks) and the late group (45 cases, the time from injury to surgery >3 weeks). Six months after operation, the recovery of bone channel, knee joint function, pain degree, stability stress, SDF-1/CXCR4 pathway-related factors in knee joint fluid and complications were compared between the two groups.
      Results The signal intensity, bone marrow tract width and T2 value of tendon-bone junction in the early group were lower than those in the late group (P <0.01).The IKDC score, Lysholm score and knee joint range of the early group at six months after surgery were higher than those of the late group, and the VAS score was lower than that of the late group (P <0.01).In the early group, the distraction distance of the lateral compartment under stress, the posterior tibial distance under stress, and the dial-up tibial rotation angles of 30° and 90° of knee flexion were lower than those in the late group six months after surgery (P <0.01).The levels of SDF-1, CXCR4, MMP-3 and MMP-13 in knee joint fluid of the early group at six months after surgery were lower than those of the late group (P <0.01). The complication rate in the early group (4.88%) was lower than that in the late group (20.00%) (P <0.05).
      Conclusions Compared with late arthroscopic knee surgery, early arthroscopic knee surgery can accelerate the recovery of bone channels, improve knee joint function and range of motion, reduce pain, improve stability stress, inhibit the expression of SDF-1/CXCR4 signal pathway, and then reduce the incidence of complications such as cartilage injury.

       

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