腓骨长肌腱复合骨形态发生蛋白和异体骨重建前交叉韧带术后骨隧道扩大的研究

Tunnel enlargement after anterior cruciate ligament reconstruction with peroneus longus muscle combined with BMP and allogeneic bone

目的:观察腓骨长肌腱复合骨形态发生蛋白和异体骨重建前交叉韧带术后骨隧道扩大的发生及变化。方法:2007年3月至2009年7月对18例(18膝)接受自体腓骨长肌腱复合骨形态发生蛋白和异体骨重建前交叉韧带的病例进行了12个月的随访。本组男14例,女4例;年龄21～47岁,平均35.5岁;右膝12例,左膝6例。于术后1周及3、6、12个月分别进行患肢CT检查,测量股骨隧道和胫骨隧道的直径并与术后1周数值进行比较,增宽≥2mm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:18例(18膝)均未出现骨隧道扩大,股骨隧道平均扩大(1.10±0.42)mm,胫骨隧道平均扩大(1.00±0.51)mm。18例股骨隧道:术后1周、3个月骨隧道宽度比较差异有统计学意义(P<0.05),术后3、6、12个月骨隧道宽度比较差异无统计学意义(P>0.05)。18例胫骨隧道:术后1周、3个月骨隧道宽度比较差异有统计学意义(P<0.05),术后3、6、12个月骨隧道宽度比较差异无统计学意义(P>0.05)。结论:腓骨长肌腱复合骨形态发生蛋白和异体骨重建前交叉韧带可以明显减少骨隧道扩大的发生,骨隧道明显增宽出现在术后3个月内,并在随后保持稳定。

Objective：To investigate the incidence and variation of tunnel enlargement after anterior cruciate ligament（ACL） reconstruction with peroneus longus muscle combined with BMP and allogeneic bone.Methods：ACL reconstructions with peroneus longus muscle combined with BMP and allogeneic bone were performed in 18 patients（18 knees）in the study from March 2007 to July 2009.Among the patients,14 patients were male and 4 patients were female,ranging in age from 21 to 47 years,with an average of 35.5 years.Twelve patients had the injuries in the right knee and 6 patients in the left knee.The CT scans were taken in a consistent manner at the 1st week and the 3rd,6th,12th months after surgery to measure tibial and femoral tunnel expansion.Results：Tunnel enlargement didn＇t happen in 18 knees.The average enlargement of 18 cases of femoral tunnel was（1.10±0.42） mm;and the average enlargement of 18 cases of tibial tunnel was（1.00±0.51） mm.There was statistical significance of femoral tunnel between the 1st week and the 3rd month after surgery（P〈0.05）;and there were no significant difference of the tunnel diameters among the 3rd,6th,and the 24th months postoperatively（P〉0.05）.There was statistical significance of tibial tunnel between the 1st week and the 3rd month after surgery（P〈0.05）;there were no significant differences of the tunnel diameters among the 3rd,6th,and 24th months postoperatively（P 〉0.05）.Conclusion：Anterior cruciate ligament reconstruction with peroneus longus muscle combined with BMP and allogeneic bone could obvious1y reduce the incidence of tunnel enlargement.The tunnel diameter obvious1y increase in 3 months after surgery,and it remains basically unchanged later.