目的探讨关节镜下富血小板血浆(platelet rich plasma,PRP)辅助3股腓骨长肌腱重建后交叉韧带(posterior cruciate ligament,PCL)的临床疗效。方法 2014年6月-2017年12月选择符合标准的58例PCL断裂患者,按随机数字表法,随机分为试验组(应...目的探讨关节镜下富血小板血浆(platelet rich plasma,PRP)辅助3股腓骨长肌腱重建后交叉韧带(posterior cruciate ligament,PCL)的临床疗效。方法 2014年6月-2017年12月选择符合标准的58例PCL断裂患者,按随机数字表法,随机分为试验组(应用PRP辅助3股腓骨长肌腱重建)和对照组(单纯4股腘绳肌腱重建),每组29例。两组患者性别、年龄、受伤侧别、Kellgren-Lawrence分级、受伤至手术时间及术前美国矫形足踝协会(AOFAS)踝-后足评分、国际膝关节文献委员会(IKDC)评分、Lysholm评分等一般资料比较差异均无统计学意义(P>0.05)。术前和术后3、12个月两组采用IKDC评分及Lysholm评分评估膝关节功能,采用AOFAS踝-后足评分评估足踝部功能;术后12个月,应用KT-2000检查(屈膝90°,30磅)评估双侧膝关节后向松弛度差异,行MRI检查评估韧带重建情况;术后3、12个月行CT检查评估股骨及胫骨骨隧道内口的扩大程度。结果两组手术均顺利完成,供腱区均无并发症发生,手术切口均Ⅰ期愈合。患者均获1年以上随访,试验组随访时间13~17个月,平均15.0个月;对照组15~20个月,平均15.4个月。术后3、12个月,两组AOFAS踝-后足评分与术前比较,以及两组间比较,差异均无统计学意义(P>0.05)。术后3、12个月,两组患者IKDC评分及Lysholm评分均较术前显著改善,术后12个月较3个月时进一步改善(P<0.05);试验组均显著优于对照组(P<0.05)。术后12个月试验组双膝后向松弛度差异<5 mm 27例,6~10 mm 2例;对照组双膝后向松弛度差异<5 mm 20例,6~10 mm 6例,>10 mm 3例;两组比较差异无统计学意义(Z=0.606,P=0.544)。术后12个月复查膝关节MRI提示所有患者PCL移植物走行良好,试验组MRI评分优于对照组(t=2.425,P=0.019)。术后3、12个月复查CT示,试验组股骨及胫骨骨隧道内口扩大程度均优于对照组,差异有统计学意义(P<0.05)。结论 PRP辅助3股腓骨长肌腱重建PCL能够显著改善膝关�展开更多
Background: The size of Hamstring autograft of less than 8.0 mm in ACL re-construction is one of the key factors that may contribute to the failure of the graft. In this study, we are going to assess the correlation o...Background: The size of Hamstring autograft of less than 8.0 mm in ACL re-construction is one of the key factors that may contribute to the failure of the graft. In this study, we are going to assess the correlation of pre-operative MRI measurement of Hamstring tendons with the intra-operative ACL graft. Thus, it may help surgeons to anticipate the needs for graft augmentation should the final graft size be smaller than expected. Methods: We retrospectively re-viewed 41 cases of ACL reconstructions in which MRI were done pre-operatively, in Hospital Pakar Sultanah Fatimah (HPSF), Muar between January 2019 until December 2022. MRI measurements of Hamstring tendon (semitendinosus: ST, and gracilis) were done by a radiologist, and the in-tra-operative notes were reviewed for the final graft size. Pearson’s correlation coefficients were calculated to determine the relationship between graft size and tendon cross-sectional area. The intraclass correlation (ICC) by using two-way mixed model with type consistency, the reliability based on average measure was 0.41 (95% CI: ?0.10, 0.69). A p-value < 0.05 was considered sig-nificant. Results: Of 105 patients with primary ACL reconstruction done be-tween January 2019 to December 2022, only 41 patients were included in this study. There was fair correlation (p = 0.048) between pre-operative MRI measurement and the graft diameter intra-operatively. The mean of 17.0 mm of combined diameter of ST and gracilis tendon in MRI may results in graft diameter of 8.3 mm. There was also positive correlation between patients’ height and the intra-operative graft size. Conclusion: These results showed good correlation between pre-operative MRI measurement of Hamstring ten-don size with the intra-operative graft size, hence it is a reliable tool to predict the Hamstring autograft size in ACL reconstruction.展开更多
文摘目的探讨关节镜下富血小板血浆(platelet rich plasma,PRP)辅助3股腓骨长肌腱重建后交叉韧带(posterior cruciate ligament,PCL)的临床疗效。方法 2014年6月-2017年12月选择符合标准的58例PCL断裂患者,按随机数字表法,随机分为试验组(应用PRP辅助3股腓骨长肌腱重建)和对照组(单纯4股腘绳肌腱重建),每组29例。两组患者性别、年龄、受伤侧别、Kellgren-Lawrence分级、受伤至手术时间及术前美国矫形足踝协会(AOFAS)踝-后足评分、国际膝关节文献委员会(IKDC)评分、Lysholm评分等一般资料比较差异均无统计学意义(P>0.05)。术前和术后3、12个月两组采用IKDC评分及Lysholm评分评估膝关节功能,采用AOFAS踝-后足评分评估足踝部功能;术后12个月,应用KT-2000检查(屈膝90°,30磅)评估双侧膝关节后向松弛度差异,行MRI检查评估韧带重建情况;术后3、12个月行CT检查评估股骨及胫骨骨隧道内口的扩大程度。结果两组手术均顺利完成,供腱区均无并发症发生,手术切口均Ⅰ期愈合。患者均获1年以上随访,试验组随访时间13~17个月,平均15.0个月;对照组15~20个月,平均15.4个月。术后3、12个月,两组AOFAS踝-后足评分与术前比较,以及两组间比较,差异均无统计学意义(P>0.05)。术后3、12个月,两组患者IKDC评分及Lysholm评分均较术前显著改善,术后12个月较3个月时进一步改善(P<0.05);试验组均显著优于对照组(P<0.05)。术后12个月试验组双膝后向松弛度差异<5 mm 27例,6~10 mm 2例;对照组双膝后向松弛度差异<5 mm 20例,6~10 mm 6例,>10 mm 3例;两组比较差异无统计学意义(Z=0.606,P=0.544)。术后12个月复查膝关节MRI提示所有患者PCL移植物走行良好,试验组MRI评分优于对照组(t=2.425,P=0.019)。术后3、12个月复查CT示,试验组股骨及胫骨骨隧道内口扩大程度均优于对照组,差异有统计学意义(P<0.05)。结论 PRP辅助3股腓骨长肌腱重建PCL能够显著改善膝关�
文摘Background: The size of Hamstring autograft of less than 8.0 mm in ACL re-construction is one of the key factors that may contribute to the failure of the graft. In this study, we are going to assess the correlation of pre-operative MRI measurement of Hamstring tendons with the intra-operative ACL graft. Thus, it may help surgeons to anticipate the needs for graft augmentation should the final graft size be smaller than expected. Methods: We retrospectively re-viewed 41 cases of ACL reconstructions in which MRI were done pre-operatively, in Hospital Pakar Sultanah Fatimah (HPSF), Muar between January 2019 until December 2022. MRI measurements of Hamstring tendon (semitendinosus: ST, and gracilis) were done by a radiologist, and the in-tra-operative notes were reviewed for the final graft size. Pearson’s correlation coefficients were calculated to determine the relationship between graft size and tendon cross-sectional area. The intraclass correlation (ICC) by using two-way mixed model with type consistency, the reliability based on average measure was 0.41 (95% CI: ?0.10, 0.69). A p-value < 0.05 was considered sig-nificant. Results: Of 105 patients with primary ACL reconstruction done be-tween January 2019 to December 2022, only 41 patients were included in this study. There was fair correlation (p = 0.048) between pre-operative MRI measurement and the graft diameter intra-operatively. The mean of 17.0 mm of combined diameter of ST and gracilis tendon in MRI may results in graft diameter of 8.3 mm. There was also positive correlation between patients’ height and the intra-operative graft size. Conclusion: These results showed good correlation between pre-operative MRI measurement of Hamstring ten-don size with the intra-operative graft size, hence it is a reliable tool to predict the Hamstring autograft size in ACL reconstruction.
