前交叉韧带单束重建股骨不同定位点的疗效评价

Postoperative evaluation of two different femoral tunnel position after single-bundle anterior cruciate ligament reconstruction

目的比较关节镜下前交叉韧带(ACL)单束重建股骨定位点在右膝11点(A点)与右膝10点(B点)术后疗效的差别。方法将97例ACL损伤患者随机分成两组:A组50例,B组47例。在关节镜下四股腘绳肌腱单束重建ACL,A组股骨定位点在A点,B组股骨定位点在B点,两组胫骨骨道定位保持一致。术后进行前抽屉试验、Lachman试验、外旋试验、KT-2000检查,并进行术前与术后的Lysholm、IKDC评分,评价两者之间疗效的差别。结果 A组术后1周与术后1年的ADT及Lachman试验阳性例数变化差异有统计学意义(P<0.05);两组外旋试验及KT-2000在134 N下屈膝30°位膝关节前后位移情况差异均有统计学意义(P<0.01),B组优于A组。术前两组Lysholm和IKDC评分差异无统计学意义(P>0.05),术后1年Lysholm及IKDC评分明显优于术前(P<0.01),术后Lysholm评分两组差异无统计学意义(P>0.05),但IKDC评分两组差异有统计学意义(P<0.01),B组优于A组。结论股骨骨道选择在A点和B点单束重建ACL,可使患者关节稳定性得到明显改善;B点在控制关节旋转稳定性比A点好,早期A点比B点易发生重建韧带松驰。

Objective To study the effects of single bundle reconstruction of anterior cruciate ligament（ACL） between the right knee 11 o′clock anchor point（A point） and right knee 10 o′clock（B point）.Methods 97 cases of ACL injuries were randomly divided into two groups of A and B.There were 50 patients in the A group and 47 patients in the B group.All of ACL injuries were treated by single bundle reconstruction.The femoral tunnels of A group were pointed at A point and the B group were pointed at B point.Postoperative the ADT,Lachman test,external rotation test,KT-2000 examination were performed,and preoperative and postoperative Lysholm IKDC scores were recorded,which were taken to evaluate the different efficacy between the two groups.Results The number of cases that ADT and Lachman test positive between the 1st week and the 1st year in group A was difference（P0.05）.The number of cases of external rotation test and KT-2000 are different（P0.01）,B group better than the A group.Preoperative Lysholm and IKDC scores in the two groups got no difference（P0.05）,the results of the treatment to the cases was significantly better than before（P0.01）,postoperative Lysholm scores has no difference in the two groups（P0.05）,but the IKDC scores between the two groups were significantly different（P0.01）,B group was better than in A group.Conclusions Joint stability can be improved when ACL is reconstructed in single bundle with the two methods.B point is better than A point in the controlling of the joint rotational stability,and A point is prone to early relaxation than B point.