前十字韧带重建术后骨隧道扩大与临床疗效的关系

Relationship between bone tunnel enlargement after anterior cruciate ligament reconstructions and clinical outcome

目的回顾性研究腘绳肌腱重建前十字韧带患者,探讨骨隧道扩大的特点、影响因素及其与临床效果的关系。方法103例自体腘绳肌腱重建前十字韧带的患者术后12～18个月进行MR检查,分别测量股骨隧道、胫骨隧道矢状位宽度并与术后1个月MRI中的骨隧道宽度对比。根据隧道扩大的程度分为4级:0级<2mm、1级2～4mm、2级4～6mm、3级≥6mm。测量股骨隧道轴线与髁间窝顶线的夹角α,胫骨隧道轴线与胫骨平台平面夹角β。以Lysholm评分测定膝关节功能,采用膝关节屈曲30°时KT-1000测量相对移动度。对股骨隧道、胫骨隧道不同级别间Lysholm评分、KT值、α值和β值进行对比。结果103例患者中共有27例(26.2%)出现了骨隧道扩大,16例股骨隧道(1级11例,2级5例),19例胫骨隧道(1级12例,2级7例),8例双侧骨隧道同时扩大。股骨隧道扩大各级别之间、胫骨隧道扩大各级别之间Lysholm评分差异无统计学意义(P>0.05)。2级股骨隧道扩大组KT值大于0级和1级组(P<0.05),2级胫骨隧道扩大组KT值大于0级和1级组(P<0.05)。2级股骨隧道扩大组角α值小于0级和1级组(P<0.05),胫骨隧道扩大各级别之间角β值差异无统计学意义(P>0.05)。结论采用腘绳肌腱重建前十字韧带术后部分患者会出现明显骨隧道扩大,扩大数值较大时会出现胫骨前移增加。股骨隧道角对股骨隧道扩大有一定影响。

Objective The purpose of this study was to observe the feature of tunnel enlargement after anterior cruciate ligament reconstructions and to investigate the influencing factors and the relationship between bone tunnel enlargement and clinical outcome. Methods There were 103 patients who accepted anterior cruciate ligament reconstructions with autogenous hamstring tendons for follow-up. Magnetic resonance imaging （MRI） offered the possibility of visualizing the bone tunnels from 12 to 18 months after surgery. The width was measured for tibial and femoral tunnel and compared to initial width. The tunnel size was graded to 4 grade depending on the increased width： grade 0（〈 2 mm）, grade 1 （2-4 mm）, grade 2 （4-6 mm） and grade 3（t〉6 mm）. The femoral tunnel angle（α） and tibial tunnel angle（β） were measured. And the comparison was made among the Lysholm and KT score as well as the ct and β value. Results Bone tunnel enlargement was observed in 27 patients （26.2%）： among them, 16 cases in femoral tunnels （11 grade 1, 5 grade 2）, 19 cases in tibial tunnels （12 grade 1, 7 grade 2）, and 8 cases in both side tunnels. There was no statistical significant difference in the Lysholm scores among the above different grades, and the KT-1000 arthrometer measurements in grade 2 was more than grade 0 and grade 1 （P〈 0.05）, and the angle ct in grade 2 was less than grade 0 and grade 1 （P〈0.05）. In tibial tunnels, there was no statistical significant difference in the angle β among those different grades. Conclusion Bone tunnel enlargement after anterior cruciate ligament reconstructions with autogenous hamstring tendons have occurred in some patients. The evident tunnel enlargement can result in more tibial forward movement. Femoral tunnel angle can affect the tunnel enlargement.