移植物不同固定方式对自体腘绳肌腱重建膝前交叉韧带术后股骨骨道影响的对比研究

Comparative study of femoral tunnel enlargement after hamstring anterior cruciate ligament reconstruction with different graft fixations

[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.