前交叉韧带重建术后骨隧道扩大的产生及转归的 MRI 随访结果

The incidence and variation of tunnel enlargement after anterior cruciate ligament reconstruction

目的观察前交叉韧带重建术后骨隧道扩大的发生及随时间的演变。方法对58例(58膝)接受自体胭绳肌腱移植、挤压螺钉固定的前交叉韧带重建病例进行了2年随访。于术后1、3、6、12和24个月分别进行患肢 MRI 检查,测量矢状位股骨隧道和胫骨隧道的宽度并与术后1个月数值进行比较,增宽≥2 mm 为隧道扩大。记录骨隧道扩大出现的时间及不同时间段隧道宽度的改变。结果 9膝(15.5%)出现股骨隧道扩大,12膝(20.7%)出现胫骨隧道扩大。2膝术后3个月内出现扩大,16膝3～6个月出现扩大,3膝6～12个月出现扩大。隧道扩大的病例术后1、3个月隧道宽度比较差异无统计学意义(P>0.05),术后6、12、24个月隧道宽度大于1、3个月(P<0.05),而6、12和24个月之间隧道宽度比较差异无统计学意义(P>0.05)。结论前交叉韧带重建术后骨隧道扩大主要出现于术后3～6个月之间,并在术后12～24个月保持稳定。

Objective To investigate the incidence and variation of tunnel enlargement after anterior cruciate ligament （ACL） reconstruction. Methods ACL reconstructions using hamstring tendons were performed in 58 patients （58 knees） in the study. MRI scans were taken in a consistent manner at 1, 3,6,12 and 24 months after surgery to measure tibial and femoral tunnel expansion. Results Femoral tunnel enlargement was observed in 9 knees （9/58,15.5%） ; Tibial tunnel enlargement was found in 12 knees （ 12/58,20. 7% ）. Of those with enlarged bone tunnels, there was no significant difference of tunnel diameters between 1 and 3 months after surgery （ P 〉 0. 05 ）. Six, 12 and 24 months postoperatively, the average tunnel diameters were larger than those of 1 or 3 months after surgery （ P 〈 0. 05 ） , however, no significant difference was found in between the tunnel diameters 6, 12 and 24 months postoperatively either （P 〉 0. 05 ）. Conclusion Tunnel expansion mainly occurs during 3 to 6 months after surgery, and it remains basically unchanged between 12 and 24 months postoperatively.