Individualized Anterior Cruciate Ligament Reconstruction with Remnant Preservation Zhang Lei, Li zhiyao Department of sports medicine, Wangjing hospit

Size: px

Start display at page:

Download "Individualized Anterior Cruciate Ligament Reconstruction with Remnant Preservation Zhang Lei, Li zhiyao Department of sports medicine, Wangjing hospit"

娇椿章
5 years ago
Views:

1 CAMPARISON OF ANATOMIC ACL RECONSTRUCTION BETWEEN SINGLE AND DOUBLE-BUNDLE RECONSTRUCTION WITH DIFFERENT METHODS Li Yanlin, Wang Guoliang, First Affiliated Hospital of Kunming Medical University [Abstract] Background There is different anatomic ACL reconstruction, so this study observed the effects of single-bundle and double-bundleacl anatomic reconstruction with different methods. Material and Methods 120 patients withacl injury were randomly divided into 4 groups:double-bundle reconstruction with conventional procedure (group A); anatomic double-bundle reconstruction in the original footprints (group B); single-bundle reconstruction with conventional procedure (group C);anatomic single-bundle reconstruction in the original footprints (group D). After the operation, the impingement between the ACL implants and intercondylar notch was evaluated with three-dimensional digital model based postoperativemri images.the results of Lachman test, anterior drawer test, and pivot shift test, Lysholm scores and IKDC ratings were analyzed between four groups. Results 11 cases (36.7%) in group A showed impingement through three-dimensional digital model after operation, 1 case (3.3%) in group B showed impingement, 9 cases (30.0%) in group C showed impingement, and no impingement in group D. The impingement rate of groups A and C was significantly higher than that of group B and D (P<0.05). TheLysholm scores, Lachman test, anterior drawer test, and pivot shift test results at 24 months after operation were significantly better than preoperation in the same group (P<0.05). The IKDC grade of groupb and D was significantly higher than that of group A and C (P<0.05). Discussion and ConclusionThe anatomic single and double bundle reconstruction in the original ACL residual footprints has lower impingement rate and higher IKDC grade. So the individual anatomic single and double bundle reconstruction is an effective method.

2 Individualized Anterior Cruciate Ligament Reconstruction with Remnant Preservation Zhang Lei, Li zhiyao Department of sports medicine, Wangjing hospital, CACMS. Background: Anterior cruciate ligament reconstruction technique include isometric reconstruction and anatomic reconstruction. But the anatomic reconstruction did not take into account the individual differences of patients. Individualized reconstruction technology can consider the specific situation of each patient. The author used the individualized positioning technology combined with the remnant preservation technique in the anterior cruciate ligament reconstruction, has obtained good clinical results. Materials: From May 2010 to October 2013, 204 cases of ACL injury underwent arthroscopic reconstruction by individualized positioning method and remnant preservation technique with autologous hamstring tendon. There were 99 male and 105 female cases. The average age was 25.8(17~43) years old, and the average history was 4.5±1.1(3~6) months. There was positive pivot shift test in 165 cases, positive Lachman test in 204 cases, positive ADT in 204 cases. According to KT 2000 test, anterior tibia transition was 7.2±2.3(5 ~ 9 mm) more than that of the contralateral limb. The Lysholm score was 55.7±5.4 (45 ~ 67), scoring excellent (95 ~ 100) for 0 cases (0%), good (84 ~ 94) for 0 cases (0%), fair (65 ~ 83) for 9 cases (4.4%) and poor (< 64) for 195 cases (95.6%). Tegner activity score averaged 3.1±0.6(2 ~ 4). Methods: Anterior cruciate ligament remnant was preserved. Femoral remnant was preserved about 2 mm, tibial remnant was completely preserved. According to the remnant, tibial and femoral tunnel were located in the center of the original footprints area. The femoral tunnel could be aimed through tibial tunnel or medial portal. RigidFix in femoral tunnel, IntraFix in tibal tunnel were used for graft fixation. Results: Postoperative follow-up time averaged 31.5±2.4 (24 ~ 42) months. On the last follow up, there was negative pivot shift test in all 204 cases. There was negative Lachman test in 190 cases but I degree positive in 14 cases. For ADT, it was negative in 184 cases, I degree positive in 18 cases, and II degree positive in 2 cases. According to KT 2000 test, anterior tibia transition was 1.9±0.7 (0 ~ 3 mm) more than that of the contralateral limb(t = 21.15, p =0.0001). Lysholm score averaged 86±5.1(81 ~ 97, t = 18.55, p = 0.001); Lysholm scale was excellent in 165 cases (80.9%), good in 30 cases (14.7%), fair in 9 cases (4.4%), and poor in 0 cases (0%) (z = 3.066, P < 0.05). Tegner activity score averaged 7.8±0.3(6~9, t=9.11, p=0.0005). So far, there was not graft failure nor cyclopia. Discussion: Currently widely used clock localization method has its disadvantages because it was without considering the individual differences of each patient. Patients got individualized reconstruction technique reference to the original insertion. Individualized reconstruction technique was really anatomic reconstruction. Conclusion: It was safe and effective to perform individualized anterior cruciate ligament reconstruction with remnant preservation. The original footprint and the remnant fiber can simulate the original anatomy of ACL without obvious complications.

3 前交叉韧带翻修的治疗策略蔡道章曾春南方医科大学第三附属医院运动医学科目的分析导致前交叉韧带重建 (ACLR) 后韧带失效的影响因素, 探讨翻修手术的策略及技术要点方法回顾性分析 2008 年 6 月至 2015 年 6 月因 ACLR 术后韧带失效来我院行翻修术的 47 例患者的临床资料, 其中男 36 例, 女 11 例, 年龄岁 ( 平均 32 岁 ), 左膝 29 例右膝 18 例结合影响学检查及术中所见分析导致 ACLR 手术失败的相关因素术后随访,Lysholm score IKDC subjective score 评价术后功能结果导致 ACLR 手术失败的相关因素包括 : 移植物选择重建方式选择韧带定位异常内固定位置异常及松动复合损伤处理不当术后康复因素感染等术前评分 : 一期翻修组 Lysholm score 65.5 IKDC subjective score 63.8; 二期翻修组 Lysholm score 55.2 IKDC subjective score 52.5 术后评分 : 一期翻修组 Lysholm score 90.1 IKDC subjective score 88.7; 二期翻修组 Lysholm score 83.6 IKDC subjective score 81.5 结论导致 ACLR 手术失败的相关因素较多, 部分病人存在多因素影响, 其中隧道定位异常最常见, 手术技术是影响 ACLR 手术最关键的因素, 适当的术后功能锻炼对关节功能的恢复有重要的影响翻修手术是解决重建失败的有效方法, 翻修手术的选择需根据重建失败的原因个体化设计关键词关节镜 ; 前交叉韧带 ; 重建 ; 翻修

4 关节镜全内技术重建膝关节前交叉韧带的临床研究孙健, 肖闻宇, 廉辉, 孙卫兵上海市第十人民医院崇明分院目的探讨取自体腓骨长肌前 1/2 部分, 关节镜下使用 tight-rope 固定重建膝关节前交叉韧带方法的可行性及临床随访效果方法回顾分析 2013 年 2 月 2015 年 3 月我院骨科收治的膝前交叉韧带断裂的患者共 31 例, 均取自体腓骨长肌前 1/2 部分, 关节镜下使用 tight-rope 固定重建膝关节前交叉韧带受伤后至接受手术时间 1 月 13 月, 平均为 5 月所有患者要求术后月来门诊随访, 采用功能评分采用 Lysholm 评分及 IKDC2000 评分结果临床随访所有的 31 例患者, 术前 Lysholm 评分平均 41.3±2.5, 术后 3 月 Lysholm 评分平均 55.3±2.3, 术后 6 月 Lysholm 评分平均 83.6±1.5, 术后 3 月 Lysholm 评分平均 91.8±0.2 术前 IKDC2000 评分 50.4±4.9, 术后 3 月 IKDC2000 评分平均 66.7±3.6, 术后 6 月 IKDC2000 评分平均 74.1±3.3, 术后 12 月 IKDC2000 评分平均 83.6±4.3 术后 6 月后 Lysholm 评分 IKDC2000 评分较术前均有显著性差异 (P<0.05) 术后无一例关节感染, 无一例踝关节不稳结论取自体腓骨长肌前 1/2 部分, 关节镜下使用 tight-rope 固定全内技术重建膝关节前交叉韧带, 方法可行, 固定稳定, 而且节约肌腱, 有良好的临床疗效

5 骨生物挤压钉固定重建前交叉韧带的生物力学研究申学振, 刘玉杰解放军总医院目的 : 利用离体山羊标本分析骨生物挤压钉重建山羊前交叉韧带的生物力学性能方法 : 取 12 月龄山羊正常膝关节 16 具, 平均分为两组, 利用山羊自体肌腱重建前交叉韧带, 编织肌腱长度及直径分别为 10cm 7mm, 实验组股骨端胫骨端应用以骨库皮质骨为材料自主研制的的骨生物挤压钉 (Ø6x20mm) 固定, 对照组采用可吸收界面螺钉 (Ø7x20mm, smith &nephew) 固定, 并以正常保留前交叉韧带的膝关节标本作为空白对照利用 Instron E10000 HDX 试验机检测不同固定方式的生物力学性能, 力学实验参数及方法如下 :50-250N 1000 循环疲劳试验分别记录疲劳试验中第个循环时系统位移, 然后立即以 20mm/s 速度拔出至固定失败拔出实验, 分别对股骨端胫骨端标本所有数据进行记录和统计分析结果 : 股骨端 : 挤压钉组最大失败载荷失效载荷均大于界面钉组, 差异有统计学意义 (P<0.05); 挤压钉组拔出刚度大于界面钉组, 但差异无统计学意义 (P>0.05); 两组第 1 次 30 次 100 次 500 次 1000 次循环的系统最大位移差异无统计学意义 (P 值 >0.05) 胫骨端 : 挤压钉组最大失败载荷失效载荷刚度均大于界面钉组, 差异有统计学意义 (P<0.05); 挤压钉组拔出刚度大于界面钉组, 差异无统计学意义 (P >0.05); 两组在第 100 次 500 次 1000 次循环中差异有统计学意义 (P<0.05); 而第 1 次第 30 次循环中最大位移两组差异无统计学意义 (P>0.05) 正常前交叉韧带循环位移均小于股骨胫骨端两种固定方式, 最大失败载荷失效载荷刚度与生物挤压钉组差别较小结论 : 生物骨挤压钉固定重建 ACL 股骨端胫骨端最大失败载荷失效载荷及刚度的力学性能优于可吸收界面螺钉, 骨生物挤压钉固定是一种良好的前交叉韧带固定方式关键词 : 前交叉韧带 ; 生物力学 ; 界面螺钉

6 关节镜下 Ethibood 线结合双 Endobutton 钢板对于治疗前交叉韧带胫骨止点撕脱性骨折的疗效评估陶军陈谱南昌大学第二附属医院摘要 : 背景 : 随着运动医学的发展, 关节镜手术已经成为了治疗前交叉韧带胫骨止点撕脱性骨折的金标准然而, 在目前关节镜手术治疗前交叉韧带胫骨止点撕脱性骨折的病人在术中及术后复查的过程中, 常有不同程度的松动此次研究的目的在于探讨关节镜下 Ethibood 线结合双 Endobutton 钢板对于治疗前交叉韧带胫骨止点撕脱性骨折的可行性及其疗效材料 :2014 年 6 月 2016 年 1 月我院采取双 Endobutton 钢板治疗急性前交叉止点撕脱骨折的病人 16 例, 男 10 例, 女 6 例, 术前查体 :Lachman 试验及前抽屉试验均呈阳性, 术前 Lysholm 评分为 43.6±4.7, 国际膝关节文献委员会 (IKDC) 膝关节主观评分为 (46.3±5.1) 分术中使用 Ethibond 线结合双 Endobutton 钢板固定骨块, 手术时间 50-70min, 平均 57min, 术后第二天复查 X 片示骨块复位满意, 术后月随访, 平均随访 8 个月, 术后 3 月复查 X 片示骨折愈合末次随访时 16 例患者 Lachman 及前抽屉试验阴性, 膝关节活动度均大于 120, 膝关节 Lysholm 评分为 90.6±2.9,IKDC 膝关节主观评分为 (93.1±4.2) 分方法 : 取常规膝前内外侧及髌正中入路, 清理骨折断端, 将骨折块予以新鲜化绕前交叉韧带止点基底部穿入 PDS 线, 导入 2 根 Ethibond 线打滑结推入关节腔用前交叉定位器定位骨床的前内侧及前外侧, 用 2.0 mm 克氏针沿定位分别转取 2 个胫骨骨隧道, 将腰穿针通过骨隧道引导 PDS 线进入关节, 将 2 股牵引线分别从 2 个骨隧道拉出, 同时拉紧 2 股 Ethibond 线的状态下用 Endobutton 钢板分别将其固定讨论 : 关节镜治疗前交叉韧带胫骨止点撕脱性骨折方法很多, 8 字缝线法是我们常用的一种方法, 常规我们将结打在骨面上, 或者用一个 Endobutton 钢板固定, 这样容易在打结时或术后产生松动, 或对线产生切割, 影响骨块固定强度因此我们改良用腰穿针沿骨隧道过线后, 可以在保持两股线张力的情况下用 Endobutton 钢板固定另一股 Ethibond 线, 使韧带一直处于紧张的状态, 改善了骨折断端的固定强度允许患者早期进行功能锻炼, 能进一步减少产生术后松动的可能性结论 : 关节镜下 Ethibood 线结合双 Endobutton 钢板治疗前交叉韧带胫骨止点撕脱性骨折, 操作简单, 创伤小, 有良好复位坚强固定等优势, 并允许膝关节早期功能活动锻炼, 获得良好疗效

7 Effectiveness comparison of anterior cruciate ligament reconstruction by ethibond excel polyester sutures combined with high-strength sutures using RigidFix for autogenous tendons fixation Lilei He; Lilian Zhao; Jisi Xin; Ting Xu Orthopaedic Sports Medicine and Arthroscopy Surgery, Foshan Hospital of TCM, Foshan, Guangdong , P.R.China; Abstract Background The anterior cruciate ligament (ACL) reconstruction is the most frequently performed ligament surgery in the knee. One pin of the RigidFix system is positioned close to the intra-articular opening of the tunnel, which could decrease the mobility of the graft in the bone tunnel. Although anterior cruciate ligament reconstruction using autologous hamstring tendon could gain satisfactory clinical results, it remains unclear whether ethibond excel polyester sutures combined with high-strength sutures is correlated with good clinical results. Our aim is to compare the effectiveness of anterior cruciate ligament (ACL) reconstruction using RigidFix for autogenous tendons fixation between by ethibond excel polyester sutures combined with high-strength sutures and by ethibond excel polyester sutures. Materials and methods Between October 2011 and August 2013, 48 cases of ACL rupture underwent ACL reconstruction using RigidFix for autogenous tendons fixation. Ethibond excel polyester sutures combined with high-strength sutures were used in 25 cases (observation group) and ethibond excel polyester sutures were used in 23 cases (control group). There was no significant difference in gender, age, side, disease duration, and preoperative Lachman test, Lysholm score, and the International Knee Documentation Committee (IKDC) score between 2 groups (P>0.05).The treatment and rehabilitation measures were identical in 2 groups. Results The operation performed smoothly. Vessel, nerve and meniscus were not injured. No complication of donor site pain and myasthenia of affected knee after operation. At 6 months and 2 years after operation, the Lachman test, the Lysholm score and the IKDC score were superior significantly to those before operation in both groups (P< 0.05), but no significant difference was found between 2 groups (P>0.05). Discussion and Conclusion Anterior cruciate ligament reconstruction by ethibond excel polyester sutures combined with high-strength sutures using RigidFix for autogenous tendons fixation presented satisfactory clinical results, whether using high-strength sutures during operation needs to be further study.

8 膝关节三维 CT 重建评估住院医师嵴发生率张旸李东明郑伟胡勇四川省骨科医院 ( 成都 ) 摘要目的 : 探讨关节镜下前交叉韧带重建术中使用住院医师嵴作为股骨端定位骨性标志的临床可行性方法 : 对 80 例在我院行膝关节 CT 三维重建的患者, 按年龄分组, 每组 20 例, 分为 A (4y-12y) B (13y-30y) C (31y-45y) D(45y-81y) 四组, 其中 B 组和 C 组为我科前交叉韧带断裂拟手术患者, 分析每组膝关节髁间窝外侧嵴 (1ateral intercondylar ridge), 即住院医师嵴 (resident ridge) 三维 CT 重建之发生率及镜下观察结果 : 4 组患者住院医师嵴发生率 :A 组 0%,B 组 15%,C 组 15%,D 组 45%, 具有显著的统计学差异 ( t=0.003, P 值 <0.01) B 组和 C 组全部患者在关节镜下采用髁间窝外侧壁后 1/3 定位 ACL 股骨止点足印区原则, 经有限髁间窝清理, 均能发现位于髁间窝外侧壁上一条白色致密纤维切迹结论 : 随患者年龄增长, 住院医师嵴在三维重建的膝关节 CT 上更易发现, 可能与膝关节运动过程中前交叉韧带股骨止点应力负载有关关节镜下前交叉韧带重建术中使用住院医师嵴作为股骨端个体化骨性定位标志尚需临床进一步研究 ACL 股骨足印区白色致密纤维切迹可做为关节镜下股骨隧道个体化非骨性定位标记关键词 : 三维 CT 重建 ; 住院医师嵴 ; 前交叉韧带股骨足印区 : 骨性标志 : 致密纤维切迹通讯作者胡勇, 副主任医师, 研究方向 : 膝关节运动损伤四川省骨科医院膝关节科 yhoo0425@vip.sina.com Evaluation of Resident Ridge Detection Rate with 3D Reconstruction of Knee CT Scan Zhang Yang, Li Dong Ming, Zheng Wei, Hu Yong Sichuan provincial Orthopeadic Hospital,Chengdu city,sichuan Province,China Corresponding Author:Hu Yong,Associate Chief Physician,research direction: Sports Medicin Injury yhoo0425@vip.sina.com Abstract Objective: To explore the clinical feasibility of using a resident ridge as a bony landmark for the femoral tunnel position in arthroscopic anterior cruciate ligament (ACL) reconstruction. Method: 80 patients who underwent knee CT scans with 3D reconstruction were divided into four age groups: A (4y-12y), B (13y-30y), C (31y-45y) and D (45y-81y), with 20 patients each. Patients in Groups B and C planned to receive surgery for their torn ACLs in our department. We analyzed the detection rate of lateral intercondylar ridge, i.e., resident ridge, in 3D reconstruction of knee CT scan, and the arthroscopic findings for B and C groups. Results: The resident ridge detection rates in Groups of A, B, C, and D were 0%, 15%, 15%, and 45%, respectively,there were statistically significant differences between

9 them (t=0.003, P<0.01). Under the arthroscopic view, the footprint was located based on the posterior 1/3 of the medial surface of the lateral femoral condyle, and a white dense fibous notch in the lateral wall of the intercondylar fossa was observed after a limited debridement in all patients of B and C groups. Conclusion: Resident ridge detection can be more easily performed in 3D reconstruction of knee CT scans as patient age increases, which is possibly related to the stress near the femoral insertion of the ACL during knee movement. Further clinical study is needed to verify the use of resident ridge as an individual bony landmark for the femoral insertion site in arthroscopic ACL reconstruction. The white dense fibrous notch in the femoral footprint of ACL can be used as an individual landmark for the arthroscopic femoral tunnel position. Key words: 3D CT Reconstruction; Resident ridge; Femoral ACL footprint;osseous landmark; White dense fibrous notch

10 Anterior Cruciate Ligament Reconstruction Using Hamstring Tendon Autograft With Preserved Infrapatellar plicae:a short-term follow-up study Chengwu Zhao 1, Zhiming Song 2 1 Sport Medicine Department of First Hospital of Jilin University,China 2 Sport Medicine Department of First Hospital of Jilin University,China Background: sual. But as for acute ACL tear with intact infrapatellar plicae patients, ACLR with Preserved Infrapatellar plicae whether or not give us some surprise in follow up study? Materials: From September 1th,2015 to October 31th 2015, 27 patients of acute unilateral ACL tear with or without meniscus injury (less than 2 weeks),17 males, 10 females, average age 31.25ys(21-51ys). 14 left knees, 13 right knee, 9 trauma cases, 12 sport injury cases,work injury 6 cases. Mean period from Injury to surgery:7.92 days (1-14 days). Meniscus tears 18 cases, ADT positive:25 cases,anterior laxityⅡ (2 cases),Ⅲ (24 cases). Methods : (1)Group : we define groups based on infrapatellar plicae whether or not intact,group A:12 cases, infrapatellar plicae is intact, group B:15 cases, infrapatellar plicae is injuried. (2) Surgery technique: All 27 patients ACLR use ipsilateral hamstring tendon with Endobutton femoral fixation and screw/spiked ligament tibial fixation. Meniscus tears sutured with fast-fix(gro Although ACL reconstruction has gained good clinical satisfaction, there are still some dissatisfaction feedback after ACLR postoperative review. Some authors believe ACLR with preserved the remnant of the ACL can bring better postoperative clinical satisfaction. They suggest that the remnant preserving technique could be an effective alternative considering its mechanical stability as well as the proprioception and vascularization recovery. Inspired by this idea, as for the infrapatellar plicae with the same ligament structure as ACL, it may also have normal or functional proprioception and vascularization. Because it hinders the observation and location of the microscopic ACLR view, we resect it as u up A 7,group B 8). Group A 12 patients, using 15# needle with PDS-II enter from medial-superior portal and reach under infrapatellar plicae, Enter to catch free end of PDS-II from medial-infra portal with arthroscopic view from medial-inferior portal. Catching PDS-II loop out from lateral-infra portal and lift up PDS-II and unfreeze view limited by infrapatellar plicae, make tunnel in tibial and femur as usual. Group B 15 patients, infrapatellar plicae is resected and others surgery technique is the same as group A. (3) Postoperative evaluation and statistical analysis: It includes objective instability Lachman test, pivot test, Lysholm score, IKDC score,rom, Berg Balance

11 Scale, Floating patellar, Infrapatellar pain, Abnormal knocking. Post-op 4 months follow-up study, statistical analysis is assessed by SPSS 18.0 through Fisher X 2 test/t-test/wilcoxon test. Discussion: (1) Infrapatellar plicae is ligamental instruction with the function of coordinated knee movement by proprioception. (2) Because acute ACL tears have short injury time, partial infrapatellar plicae and pad are intact, we have a try to improve our surgery technique with aim of preservation normal partial infrapatellar plicae and pad. While in the follow-up study, group A and B are different in IKDC score, Berg Balance Scale, Floating patellar, Infrapatellar pain, Abnormal knocking and same in Lachman test, pivot test,rom. Intact infrapatellar plicae may contribute many factors during flex and extend(relieve patellofemoral joint surface stress and adjust knee neural feedback). (3) 12 cases (group A) are recruited strictly, all are injured in two months with the same surgery technique. Post-op follow-up study evaluations by international universal standards for ACLR. (4) Pitfall: the study just include 12 cases for preserved intact infrapatellar plicae ACLR, and the follow-up study is just 4 months, no second-look under arthroscopy, so we should continue to add cases an prolong follow-up time. Conclusion : There are a better satisfaction in the group with preserved infrapatellar plicae ACLR during short term post-operation follow-up. Patients suffered infrapatellar pain and abnormal knocking decrease, knee joint effusion quantity decreased significantly. So acute ACL tears patients with intact infrapatellar plicae, we can increase post-op satisfaction by surgery technique improved.

12 关节镜下前交叉韧带胫骨双束股骨单束重建术与传统单束重建术的中期临床疗效对比李卫平宋斌杨睿侯景义陈仲谭伟权中山大学孙逸仙纪念医院运动医学科, 广州市, [ 摘要 ]: 目的比较关节镜下膝关节前交叉韧带 (anterior cruciate ligament,acl) 胫骨双束股骨单束重建术与传统单束重建术的近期临床疗效方法 : 自 2006 年 5 月至 2007 年 12 月对 76 例前交叉韧带断裂患者分别采用胫骨双束股骨单束重建 (A 组 ) 和传统单束重建 (B 组 ), 均以自体腘绳肌腱作为移植物, 移植物固定均采用界面螺钉固定, 其中 A 组 35 例 (35 膝 ), 将移植物反折编织形成六股人字形移植物,B 组 41 例 (41 膝 ), 采用传统单束重建术, 将移植物返折成六股移植物, 观察两组近期术后疗效, 以 Lysholm 评分 Larson 评分及 IKDC 评分评价比较手术前后膝关节功能, 以 MRI 及 X 线观察骨隧道变化情况结果 52 例患者获得随访,A 组 23 例, 随访时 36~47 个月, 平均 41 个月,B 组 29 例, 随访时间 38~48 个月, 平均 43 个月关节活动度均正常,A 组 Lysholm 评分由术前 62.5±4.1 分提高到 91.2±2.8 分 ;Larson 评分由 63.3±3.6 提高到 92.5±2.3,IKDC 评分由 64.6±2.8 提高到 94.5±3.8, 差异均有统计学意义 ;B 组 Lysholm 评分由术前 63.2±3.5 分提高到 89.8±3.5 分 ;Larson 评分由 61.8±4.1 提高到 90.5±3.0,IKDC 评分由 63.7±2.9 提高到 92.2±2.9, 差异均有统计学意义 ; 两组相比术前术后均无明显差异 ; 复查 MRI 见,A 组 2 例患者出现骨隧道扩大,B 组 5 例患者出现骨隧道扩大, 所有患者均未见关节间隙变窄, 均未出现螺钉松动移植物松动结论胫骨双束股骨单束与传统单束重建 ACL 相比近期疗效相当, 疗效满意, 胫骨双束股骨单束重建在生物力学研究中对关节旋转稳定性上优于传统单束重建, 但临床疗效的优越性需大样本远期的临床观察作进一步研究 [ 关键词 ] 膝关节 ; 前交叉韧带 ; 关节镜检查 1

211 better than those in the control group, with significant difference between two groups (P < 0.05). The ocular hypertension of patients in the cont

211 better than those in the control group, with significant difference between two groups (P < 0.05). The ocular hypertension of patients in the cont 210 毛果芸香碱联合拉坦前列素治疗原发性急性闭角型青光眼的疗效观察符元党 1, 郑振优 2, 林再雄 2, 周吉良 1. 昌江黎族自治县中西医结合医院, 海南昌江 572700 2. 海南医学院附属医院眼科, 海南海口 570100 1 摘要 : 目的探讨