功能支具对前交叉韧带重建术后膝关节软骨退变和临床预后的影响：基于定量磁共振影像评价的研究

关键词：前交叉韧带  功能支具  磁共振成像  软骨退变

Keywords:anterior cruciate ligament reconstruction  function brace  magnetic resonance imaging  cartilage degeneration

摘要：

      摘要 目的：探究前交叉韧带重建(anterior cruciate ligament reconstruction， ACLR)后使用功能支具（function brace，FB）是否改善术后2年软骨退变，并系统评估其对关节症状、等速肌力、下肢功能等临床预后的影响。 方法：华山医院运动医学科2014年1月—2015年1月ACLR病例按纳入标准和排除标准进行筛选。主观评价包括：Tegner活动评分、Marx活动评级量表、Lysholm膝关节评分量表、膝关节损伤与骨关节炎评分。客观评价包括：关节查体、等速肌力测试、磁共振扫描（MR）。膝关节MR扫描采用T2-mapping序列，定量分析在6个区域进行，分别为内侧胫骨、外侧胫骨、内侧股骨、外侧股骨、髌骨、股骨滑车。各区域再分为浅层、深层及全层作定量分析，测量T2值。 结果：研究纳入34例患者，26例（26/34，76.5%）完成随访，其中24例（24/34，70.6%）获客观评价。根据术后是否使用FB分为FB组和非FB组。FB组12例，平均佩戴12.6周，平均年龄24.3±5.3岁，男/女为10/2，平均随访25.4个月；非FB组14例，平均年龄26.6±5.0岁，男/女为11/3，平均随访24.1个月。FB组和非FB组的内侧股骨全层（fMF）T2值分别为38.4±6.4和46.7±3.2，P=0.003；内侧股骨浅层（sMF）T2值为45.7±9.2和56.5±4.2，P=0.005；内侧股骨深层（dMF）为31.2±6.7和37.1±3.5，P=0.010。其余各区域关节软骨T2值、等速肌力指标、关节查体，以及各项患者主观评分在两组间均未见显著差异。 结论：应用FB能够改善ACLR后膝关节MF软骨的早期退变，但并未对患者术后2年的关节症状、下肢力量、关节功能以及患者主观评分产生显著影响。

Abstract:

      Abstract Objective:To evaluate whether the application of function brace（FB）could alleviate cartilage degeneration and its influence on symptoms， muscle strength， knee function， and patients reported outcomes at 2 years after the anterior cruciate ligament reconstruction (ACLR). Method:The patients accepting ACLR between January 1st 2014 and January 1st 2015 were screened under inclusion and exclusion criteria. The subjective evaluation included: Tegner Activity Score， Marx Activity Rating Scale， Lysholm Knee Scoring Scale， Knee Injury and Osteoarthritis Outcome Score(KOOS). The objective evaluation included:knee physical exam， isokinetic muscle strength， magnetic resonance(MR) scanning. The MR scanning was performed using the T2-mapping sequence in 6 regions， respectively the medial tibia (MT)， lateral tibia (LT)， medial femur (MF)， latera femur (LF)， patella(Pa)， trachlea(Tr). In each region， the quantitive assessment of T2 value was performed in the superficial(s) layer， deep layer(d)， and full(f) layer， respectively. The P value less than 0.05 was considered as statistically significant. Result:A total of 34 patients were included and 26 patients accepted follow up. The patients were grouped based on using the FB or not after ACLR: the FB group and the non-FB group. The FB group included 12 patients with the 12.6 weeks of meanly wearing time，the 24.3±5.3-years-old of mean age，the 10/2 of male/female and the 25.4 months of mean follow up period. The non-FB group included 14 patients with the 26.6±5.0-years-old of mean age，the 11/3 of male/female，the 24.1 months of mean follow up period. The T2 value of the fFM was respectively 38.4±6.4 and 46.7±3.2， P=0.003; the sMF was 45.7±9.2 and 56.5±4.2，P=0.005; the dMF was 31.2±6.7 and 37.1±3.5，P=0.010 in the FB group and non-FB group. The T2 value of other regions， the isokinetic muscle strength， the knee physical exam， and subjective evaluation outcomes were not statistically significant difference between the 2 groups. Conclusion:The using of the FB might alleviate the MF cartilage degeneration after ACLR， but not affect the symptoms， muscle strength， knee function， and patients reported outcomes at 2 years follow-up.