ACUTE TEARS OF THE ANTERIOR CRUCIATE LIGAMENT - SURGICAL VERSUS CONSERVATIVE TREATMENT
ACUTE TEARS OF THE ANTERIOR CRUCIATE LIGAMENT - SURGICAL VERSUS CONSERVATIVE TREATMENT
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DOI：
10.2106/00004623-198870100-00007
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发表时间：
1988-12-01
影响因子：
5.3
通讯作者：
ZOLTAN, DJ
中科院分区：
文献类型：
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作者：
CLANCY, WG;RAY, JM;ZOLTAN, DJ
在一项为期八年的前瞻性研究中，比较了前交叉韧带急性撕裂的手术治疗和保守治疗，对 92 名通过关节镜检查或关节切开术证实撕裂的患者进行了治疗并进行随访。治疗的选择完全取决于轴移试验的结果是否被分级为不存在、微量或轻度（非手术治疗）或中度或重度（手术治疗）。手术治疗包括撕裂韧带的初步修复和髌腱移植物的增强。 22 名患者接受非手术治疗，并在 24 至 82 个月（平均 48 个月）后评估结果。 70 名患者接受了手术治疗，其中 52 名（约 70%）在 24 至 100 个月（平均 48 个月）后返回进行随访；另外十八名患者回答了问卷。在非手术组中，大约一半的结果被评为优秀或良好，另一半被评为一般或失败。在手术组中，除两名患者外，其余患者均取得了优异或良好的结果；两名患者获得了公平的结果。没有结果被评为失败。这项研究的结果表明，当枢轴移位测试不是强阳性时，一半的患者在接受非手术功能康复计划治疗后会表现得相当好。在这项研究中，膝关节更不稳定的患者在修复和增强手术后的结果比之前报道的仅初次修复后的结果要好得多。
In a prospective eight-year study comparing surgical and conservative treatment of acute tears of the anterior cruciate ligament, ninety-two patients in whom a tear had been confirmed either by arthroscopy or by arthrotomy were treated and could be followed. The choice of treatment was determined entirely by whether the result of a pivot-shift test was graded as absent, trace, or mild (non-operative treatment) or as moderate or severe (surgical treatment). Surgical treatment consisted of primary repair of the torn ligament and augmentation with a patellar tendon graft. Twenty-two patients were treated non-operatively, and the results were evaluated after twenty-four to eighty-two months (average, forty-eight months). Seventy patients were treated surgically, and fifty-two of them (approximately 70 percent) returned for followup after twenty-four to 100 months (average, forty-eight months); an additional eighteen patients answered a questionnaire. In the non-operative group, about half of the results were graded as excellent or good and half, as fair or a failure. In the surgical group, all but two of the patients had an excellent or a good result; two patients had a fair result. No result was graded as a failure. The results of this study suggest that when the pivotshift test is not strongly positive, half of the patients will do reasonably well after treatment with a non-operative program of functional rehabilitation. The patients in this study who had a more unstable knee had far better results after a repair and augmentation procedure than have been previously reported after primary repair alone.