自体腓骨长肌腱移植重建前交叉韧带术后对供区踝关节和下肢功能影响的研究

关键词：前交叉韧带  腓骨长肌腱  腘绳肌肌腱  足踝功能  平衡  康复

Keywords:anterior cruciate ligament  peroneal long tendon  hamstring tendon  foot and ankle function  balance  rehabilitation

摘要：

      摘要 目的：观察采用自体腓骨长肌腱（PLT）移植重建膝关节前交叉韧带术后对供区踝关节和下肢运动功能的影响。 方法：纳入2021年6月—2022年8月在东南大学附属中大医院和常州市体育医院就诊采用自体腓骨长肌腱移植患者23例（PLT组），对照组招募同时期采用自体腘绳肌腱移植患者23例。两组患者性别、年龄、BMI、术侧等一般资料无显著性差异（P>0.05），分别比较手术6个月后PLT组患侧与同组健侧、对照组患侧之间踝关节内外翻的相对峰力矩、关节活动度、本体感觉、VAS、足踝功能评分、Lysholm评分、平衡和单足跳等下肢运动功能情况。 结果：与同组健侧和对照组相比，PLT组患侧踝关节的VAS、足踝功能评分、内外翻活动度和本体感觉方面无显著性差异（P>0.05）；而在60°和180°角速度下的踝外翻相对峰力矩下降、内外翻力矩比值（I/E）升高、平衡功能内外向摆幅和运动轨迹长增加（均P<0.05）；与对照组相比，PLT组患侧下肢单足跳距离和下肢对称指数相对更好（P<0.05）。 结论：PLT移植重建ACL具有良好的功能预后，对供区踝关节VAS、关节活动度、本体感觉和足踝功能评分影响不大，且下肢整体运动功能相对更优，但供区踝外翻肌力、内外翻力矩比（I/E）和下肢平衡功能均下降，应给予关注，以有利于制定更有针对性的康复处方。

Abstract:

      Abstract Objective：To observe the effects of anterior cruciate ligament （ACL） reconstruction by autograft peroneal longus tendon （PLT） on the motor function of ankle joint and lower limb. Method：From June 2021 to August 2022， twenty-three patients with autologous peroneus longus tendon transplantation in Zhongda Hospital Affiliated to Southeast University and Changzhou Sports Hospital were enrolled （PLT group）， and twenty-three patients with autologous hamstring tendon transplantation in the same period were enrolled in the control group. Six months post-operation, the relative peak torque of ankle inversion and eversion, joint range of motion, proprioception, VAS score, foot and ankle function score, Lysholm scale， balance and hop lower limb motor function were compared between the affected side of PLT group and the healthy side, and with the control group. Result：There were no significant differences in gender， age， BMI， operative side and other general data between the two groups （P>0.05）. Compared with the healthy side and the control group， there were no significant differences in VAS， ankle function scores， pronation motion and proprioception of the affected ankle in PLT group（P>0.05）. However, at 60° and 180° angular velocities， the relative peak moment of ankle variation decreased， the ratio of internal and external variation moment （I/E） increased， and the swing amplitude and trajectory length of the balance function increased（all P<0.05）. Compared with the control group， the hop distance and limb symmetry index（LSI） of the affected lower extremity in PLT group were better （P<0.05）. Conclusion：ACL reconstruction with PLT transplantation has a good functional prognosis. The impact on the VAS， range of motion， proprioceptive and ankle function scores on the donor site ankle joint， and the overall motor function of the lower limb is relatively better. However, a decrease of the ankle valgus muscle strength，the ratio of I/E and balance function on the lower limb at the donor site should be addressed to formulate more targeted rehabilitation prescriptions.