摘要
[目的]探讨自体腘绳肌腱重建膝前交叉韧带,移植物不同固定方式对术后股骨隧道的影响,与临床疗效关系。[方法]88例前交叉韧带损伤病例行关节镜下自体半腱肌、股薄肌腱重建前交叉韧带,根据移植物股骨侧固定方式不同,分为三组。A组26例,采用Endobutton固定;B组22例,采用可吸收挤压螺钉固定;C组40例,采用Rigidfix固定。术后平均随访16.5个月,进行MRI检查,测量矢状位骨道开口、开口1 cm、骨道最宽处三点骨道直径,以术后1周对应部位骨道直径为衡量标准,对其差值进行统计学分析。采用Lysholm评分评估各组临床疗效。[结果]3组病例前交叉韧带术后骨道直径均有不同程度增宽。在股骨侧骨道最宽处、开口1 cm处,3组测量结果两两对比有统计学差异(P<0.05),B组增宽明显,C组骨道增宽最小;在股骨骨道开口处,C组骨道增宽程度最小(P<0.05),A、B组无对比差异(P>0.05)。A、C组股骨骨道形态呈线形;B组股骨骨道形态呈锥形。所有病例关节稳定性良好,无1例出现不稳。术后Lysholm评分,A组(94.4±2.9)分,B组(93.4±3.6)分,C组(96.3±2.7)分,三组间比较无显著差异(P>0.05)。[结论]移植物固定方式影响前交叉韧带术后骨道扩大,是骨道扩大发生的重要因素;固定方式、骨道扩大程度与术后临床疗效无相关性。
[ Objective] To compare the changes in femnral bone tunnel after arthroscopically assisted hamstring ACL reconstruction with different graft fixations and investigate the relation with clinical effect. [ Method] Eighty-eight cases in three groups were included and underwent hamstring ACL reconstruction with different temoral graft fixations for average 16.5 months follow-up evaluation. Twenty-six cases in group A received Endobuttnn fixation, twenty-two cases (group B) received inteflerence screw, and forty cases (group C)received Rigidfix system. Femoral bone tunnel diameters at the articular line level, the widest point, 1 cm a- way from tunnel aperture on sagittal MRI were compared at one week postoperatively. Lysholm score was used to evaluate the clinical effect. [ Result] Tunnel enlargement ',tfter ACL surgery was noted in the three groups. At the femoral widest point and 1 cm away from tunnel aperture, the tunnel enlargement was larger in group B and smaller in group C. At the femoral articular line level, the bone tunnel enlargement in group C was smallest. There was no difference between those of groups A and B. The shape of femoral tunnel was lineal in groups A and C,and conical in group B. No significant difference was found by Lysholm score. [ Conclu- sionl The type of graft fixation is a major factor in the development of tunnel enlargement after ACL surgery. No correlation between graft fixation,bone tunnel enlargement and clinical effect has been found.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2010年第2期106-109,共4页
Orthopedic Journal of China
关键词
前交叉韧带承建
移植物固定
骨道扩大
腘绳肌腱
膝关节
anterior cruciate ligament reconstruction
graft fixation
tunnel enlargement
hamstring tendon
knee