摘要目的 比较膝关节前交叉韧带(ACL)损伤后,采用关节镜下自体腘绳肌腱早期重建与晚期重建ACL的临床疗效.方法 回顾性分析2005年7月至2008年7月间采用自体腘绳肌腱重建ACL的95例ACL损伤患者资料,其中早期重建组(伤后2周内实施手术)31例,男21例,女10例;平均年龄为29.3岁.晚期重建组(伤后2～6个月实施手术)64例,男45例,女19例;平均年龄为31.5岁.两组患者的性别、年龄、术前Lysholm评分、国际膝关节文献委员会(IKDC)评定结果等术前指标差异无统计学意义(P>0.05),具有可比性.术后对患者进行体格检查,比较两组患者术后的疼痛消除时间、肿胀消除时间、恢复正常关节活动度(与健侧相同)的时间、Lysholm评分、IKDC评定结果等.结果 早期重建组31例患者术后获平均22.4个月(8～32个月)随访.晚期重建组64例患者术后获平均21.5个月(11～33个月)随访.早期重建组疼痛消除时间[(35.6±3.2)d]、肿胀消除时间[(14.7±2.7)d]、恢复正常关节活动度时间[(48.8±4.8)d]均长于晚期重建组[(21.5±2.6)、(8.5±2.1)、(34.5±4.1)d],差异均有统计学意义(P<0.05).末次随访时膝关节IKDC评定结果:早期重建组A级12例,B级15例,C级4例;晚期重建组A级26例,B级29例,C级9例,两组比较差异无统计学意义(x~2=4.112,P=0.250).两组患者术后末次随访时Lysholm评分平均分别为(89.6±6.9)、(91.5±7.4)分,差异无统计学意义(t=0.677,P=0.500).结论 早期重建与晚期重建ACL的近期临床疗效相近,但早期重建ACL者术后康复时间长于晚期重建者,远期疗效有待于进一步观察.

abstractsObjective To compare the clinical outcomes of early reconstruction versus late reconstruction of anterior cruciate ligament(ACL)with hamstring tendon autograft.Methods From July 2005to July 2008,95 patients underwent ACL reconstruction with hamstring tendon autograft.Thirty-one cases received early reconstruction(2 weeks after injury)and 64 late reconstruction(2 to 6 months after injury).The clinical outcomes of the 2 groups were statistically compared(t and x~2 tests)in terms of physical examination results,time for pain and swelling relief,time for normal knee range of motion(ROM),International Knee Documentation Committee(IKDC)and Lysholm scores.Results The patients receiving early reconstruction and late reconstruction were followed up for an average duration of 22.4 months(8 to 32 months)and 21.5 months(11 to 33 months)respectively.No statistically significant differences were found in the IKDC and Lysholm scores between the 2 groups(P > 0.05),but early reconstruction group had significantly longer time for pain[[(35.6 ± 3.2)d vs.(21.5 ± 2.6)d]and swelling relief[(14.7 ± 2.7)d vs.(8.5 ±2.1)land for normal knee ROM[(48.8± 4.8)d vs.(34.5±4.1)d](P < 0.05).Conclusion Early and late ACL reconstructions may lead to similar clinical outcomes,but patients undergoing early reconstruction may need a longer period of rehabilitation.