关节镜下可吸收螺钉与金属螺钉重建ACL术后比较

关节镜下可吸收螺钉与金属螺钉重建ACL术
后比较
【摘要】目的膝关节镜下采用可吸收界面螺钉与金属界面螺钉重建膝关节前交叉韧带术后结果比较。

方法选择随访1年以上采用可吸收界面螺钉和金属界面螺钉，自体骨髌腱骨移植肌腱重建膝前交叉韧带105 例，分为3个组：股骨及胫骨隧道均采用可吸收界面螺钉固定60 例为Ⅰ组；股骨隧道采用可吸收界面螺钉而胫骨用金属界面螺钉固定25 例为Ⅱ组；股骨及胫骨隧道均采用金属界面螺钉固定20 例为Ⅲ组。

术前术后物理检查，包括：抽屉试验、Lachman试验、Pivot shift试验，此外放射线拍片、KT2000测定，最后Lysholm 膝关节评分。

结果术前Lysholm膝关节评分平均值：Ⅰ组58.8分，Ⅱ组56.1分，Ⅲ组56.9分，术后恢复为Ⅰ组89.6分，Ⅱ组91.6分，Ⅲ组89.7分。

术前KT2000测定平均值：Ⅰ组6.89 mm，Ⅱ组6.88 mm，Ⅲ组7.15 mm，术后恢复为Ⅰ组2.95 mm，Ⅱ组2.86 mm，Ⅲ组3.04 mm。

术后6周至3个月间复查，只有Ⅰ组出现膝关节轻度弛缓症状，但以后逐渐恢复，与另外两组比较未见统计学差异。

结论采用两种界面螺钉不管在关节稳定性还是术后并发症上均没有统计学差异。

只是术后3个月内均采用可吸收界面螺钉组有轻度弛缓症状，故作者提倡股骨用可吸收界面螺钉、胫骨用金属界面螺钉，而且术后3个月内有必要采取支具等辅助措施进行功能康复。

【关键词】前交叉韧带重建可吸收界面螺钉金属界面螺钉
Comparison after Absorbable and Metal Interference Screw
Fixation in Arthroscopic Anterior Cruciate Ligament Reconstruction
Abstract：Objective To compare the post operative results between the patient group which used absorbable interference screw and metal interference screw during ACL reconstruction surgery. Methods The study is based on 105 patients who underwent arthroscopic with autogenous BPTB anterior cruciate ligament reconstruction with absorbable and metal screws and those who underwent more than 1 year of follow up， 60 patients were classified into group 1 where absorbable interference screw was used to fixate femur and tibia， and 25 patients fell into group 2 where absorbable interference screw was used on femur and metal interference screw on tibia， and 20 patients were classified into group 3 where metal interference screw was used on both the femur and tibia，Physical exam such as Anterior draw test， Lachman test， and Pivot shift test were conducted on all these patients before and after the surgery， and during the last follow up visit， and Lysholm knee score was taken， and after KT2000 arthrometer and simple radiological exams were performed， the results were analyzed. Results Clinical analysis of the obtained data showed that average preoperative Lysholm knee score of group 1 was 58.8，
56.1 for group 2， and 56.9 for group 3. At the last follow up visit the average score improved to 89.6 for group 1， 91.6 for group 2， and 89.7 for group 3. In comparison to preoperative KT2000 maximal manual side to side difference (STSD) for group 1 was 6.89 mm. 6.88 mm for group 2 and 7.15 mm for group 3. Post operative KT2000 improved to 2.95 mm for group 1， 2.86 mm for group2， and 3.04 mm for group 3. Statistically significant manifestation of relaxation symptoms were found only in group 1 between the 6th week and the 3rd month after the operation. Conclusion The data obtained during last follow up visit after the surgery showed no statistically significant difference in the stability of joints and the prevalence of complication was found between the two interference screws. When absorbable interference screw was used alone the fixation was loose for the first 3 months. In order to prevent such loosening and to maximize the advantage of absorbable interference screw， the authors recommend that absorbable interference screw be used for the fixation of femur and metal interference screw for the fixation of tibia and take brace rehabilitation until postoperation 3 months.
Key words： ACL reconstruction； absorbable interference screw； metal interference screw。