| 吕良友,张文彬,周琴,等.中空型人工韧带改良过顶位重建治疗青少年前交叉韧带损伤.骨科,2026,17(4): 305-311. |
| 中空型人工韧带改良过顶位重建治疗青少年前交叉韧带损伤 |
| Modified over-the-top reconstruction with hollow-type artificial ligament for adolescent anterior cruciate ligament injuries |
| 投稿时间：2025-09-29 |
| DOI：10.3969/j.issn.1674-8573.2026.04.001 |
| 中文关键词: 中空型人工韧带 过顶位技术 关节镜检查 青少年 前交叉韧带 前外侧韧带 |
| 英文关键词: Hollow-type artificial ligament Over-the-top Arthroscopy Adolescents Anterior cruciate ligament Anterolateral ligament |
| 基金项目:厦门市医工结合指导性项目（3502Z20244ZD2008） |
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| 中文摘要: |
| 目的 观察中空型人工韧带改良过顶位（over-the-top，OTT）重建前交叉韧带（anterior cruciate ligament，ACL）及前外侧韧带（anterolateral ligament，ALL）治疗青少年ACL损伤的临床疗效。方法 前瞻性选取2023年3月至2024年3月厦门市同安区中医医院骨伤科收治的38例单侧ACL断裂的青少年患者作为研究对象，男22例，女16例；年龄为（13.4±1.5）岁（11~15岁）；左膝20例，右膝18例；合并半月板损伤23例，其中内侧半月板损伤12例，外侧半月板损伤11例；Lachman试验Ⅰ度松弛8例，Ⅱ度松弛16例，Ⅲ度松弛14例。所有患者均采用中空型人工韧带改良OTT术式重建ACL及ALL。记录患者术前及术后3个月、1年的疼痛视觉模拟量表（visual analogue scale，VAS）评分、膝关节主动活动度、Lachman试验、轴移试验、Lysholm评分、Tegner评分及国际膝关节文献委员会（International Knee Documentation Committee，IKDC）评分，分析结果并评估该术式的临床疗效。结果 本组患者随访时间为（14.5±2.6）个月。末次随访时，Lysholm评分由术前（49.16±3.25）分提升至（91.67±3.86）分，IKDC评分由（45.05±4.48）分提升至（86.57±6.44）分，VAS评分由（5.93±1.32）分降至（0.67±0.44）分，差异均有统计学意义（P<0.05）。KT-1000健-患侧位移差值由术前（9.97±3.28） mm显著改善至末次随访的（0.97±0.88） mm（P<0.05）；末次随访时，Lachman试验及轴移试验阴性率分别为100%与94.7%。Tegner评分由术前的2（2，3）分提升至末次随访的7（6，8）分（P<0.05）。患者术后重返运动时间为（8.4±1.5）周，重返伤前或更高运动水平的比率为89.5%（34/38）。术后1年MRI显示移植物愈合良好，信噪比值为2.5±0.8。影像学评估未见下肢力线异常及生长发育受限，所有患者均未发生移植物再断裂、感染、膝关节僵硬等严重并发症。结论 运用中空型人工韧带通过改良OTT重建ACL及ALL治疗青少年ACL损伤具有损伤小、恢复快及并发症少的优势，可以让患者重获良好的膝关节稳定性及功能评分，值得临床推广应用。 |
| 英文摘要: |
| Objective To evaluate the clinical efficacy of modified over-the-top (OTT) reconstruction of the anterior cruciate ligament (ACL) and anterolateral ligament (ALL) using a hollow-type artificial ligament in the treatment of ACL injuries in adolescents. Methods A total of 38 adolescent patients with unilateral ACL rupture who were admitted to the Department of Orthopedics, Tong'an Hospital of Traditional Chinese Medicine from March 2023 to March 2024 were prospectively enrolled, including 22 males and 16 females, with age of 13.4±1.5 years (range, 11-15 years). The left knee was involved in 20 cases and the right knee in 18 cases. Concomitant meniscal injuries were observed in 23 cases, including 12 with medial meniscal injuries and 11 with lateral meniscal injuries. Lachman test revealed grade Ⅰ laxity in 8 cases, grade Ⅱ laxity in 16 cases, and grade Ⅲ laxity in 14 cases. All patients underwent ACL and ALL reconstruction using a hollow-type artificial ligament with a modified OTT technique. Pain visual analogue scale (VAS) scores, knee range of motion, Lachman test results, pivot shift test results, Lysholm scores, Tegner scores, and International Knee Documentation Committee (IKDC) scores were recorded preoperatively and at 3 months, and 1 year postoperatively. The clinical efficacy of this technique was then analyzed and evaluated. Results All patients were followed up for (14.5±2.6) months. At the final follow-up, the Lysholm score significantly improved from 49.16±3.25 preoperatively to 91.67±3.86, the IKDC score increased from 45.05±4.48 to 86.57±6.44, the VAS score decreased from 5.93±1.32 to 0.67±0.44, with all differences being statistically significant (P<0.05). Regarding objective stability, the side-to-side difference measured by KT-1000 improved significantly from (9.97±3.28) mm preoperatively to (0.97±0.88) mm at the final follow-up (P<0.05). The negative rates of the Lachman test and pivot-shift test were 100% and 94.7%, respectively. The Tegner score improved from 2 (2, 3) preoperatively to 7 (6, 8) at the final follow-up (P<0.05). The mean time to return to sports was (8.4±1.5) weeks, and 89.5% (34/38) of patients returned to their preinjury or higher activity levels. MRI at 1 year postoperatively showed good graft healing, with signal-to-noise quotient of 2.5±0.8. Radiographic evaluation revealed no lower limb malalignment or growth restriction. No serious complications, such as graft rerupture, infection, or knee stiffness, were observed. Conclusion The utilization of a hollow-type artificial ligament via modified OTT technique for ACL and ALL reconstruction in adolescents with ACL injuries offers advantages such as minimal invasiveness, rapid recovery, and a low complication rate. It enables patients to achieve excellent knee stability and functional scores, making it worthy of clinical promotion and application. |
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