LARS人工韧带重建前交叉韧带术后骨隧道变化特点的研究

Changes of bone tunnel after anterior cruciate ligament reconstruction using LARS artificial ligaments

目的探讨LARS人工韧带重建前交叉韧带（ACL）术后骨隧道的变化特点及可能的影响因素。方法2004年8月至2007年4月应用LARS人工韧带重建43例单纯ACL损伤患者，W31例，女12例；左膝19例，朽膝24例；年龄17～48岁，平均27．5岁。于术后1、3、6、12、24、36个月分别行膝关节x线片和CT检查，记录各个时间点胫骨和股骨骨隧道的宽度。骨隧道增宽采用Peyrachr等提出的分级办法进行评定。末次随访时根据Lyshohn评分标准评定膝关节功能，应用KT-1000。”测量膝关节的松弛度。结果43例患者术后获36～49个门（平均39．5个月）随访。未次随访时仅3例患者出现骨隧道1级增宽，均为术后6个月发生于股骨隧道近关节面水平，平均增宽（2．5±0．3）mm。无一例患者出观2级和3级骨隧道增宽。不同时间点股骨、胫骨骨隧道宽度比较差异均无统计学意义（P〉0．05），X线片与CT测时结果基本一致，二者比较差异均无统计学意义（P〉0．05）。末次随访时3例骨隧道1级增宽患行Lyshohn评分平均为（94．5±4．6）分，KT-1000前移差值平均为（1．5±1．1）mm；40例0级增宽患糟Lyshohmm评分平均为（95．6±4，8）分，KT-1000“前移差值平均为（1．4±1．5）mm。结论LARS人工劬带重建ACL术后骨隧道增宽并不硅著，这种变化特点可能与LARS人工韧带移植物的特性及固定方法不同有关。

Objective To observe ehanges of bone tunnel after anterior erueiate ligament （ACI,） reconstruction using I.ARS artifieial ligaments. Methods From Auguse 2004 to April 2007, we trealed 43 patients ith ACI, injury （in 19 left and 24 right knees） with ACI. reconstruction using LARS artificial ligaments. They were 31 males and 12 females, 17 to 48 years of age （average, 27.5 years）. X-ray and CF examimflions were ctmdta＇ted respectively at 1, 3, 6, 12, 24 and 36 months postsurgery to measure en- fargemenls of the tibial and femoral hmnels aeeording !o the grading system bv Peyraehe el al. At the lasl [bllnw-up. Lvshohn kltee scoring was used to evaluate knee functional reeoveLw and KT-IOO0TM test to evaluate the anterior and poslerior stability of the knee. Results Follow-ups lasted 36 to 49 months for the 43 patienls （average, 39.5 months） . Only 3 eases of bone tunnel enlargement of grade 1 occurred 6 months postsm＇gery, all in the femoral tunnel near the level of artie, ular surface, with an average tunnel expansion of 2.5 ＋ 0.3 ram. No enlargements of grade 2 or 3 were observed. There were no statislieally significant differenees in bone tunnel any time poin! （ P 〉 0.05） . The measurements by X-ray and CT examina- tions were quite the same. AI the lasl follow-up, the Lysholm score and KT-IO00TM anterior translation value for the 3 eases of glude I tunnel enlargement were respectively 94.5 ＋ 4.6 points anti 1.5 ＋ 1. 1 ram, and respectively 95.6 ＋ 4.8 poinls and 1.4 ＋ l. 5 mm for the 40 eases of grade 0 tunnel enlargement. Conclusions Bone tunnel eulargement may nol occur eommunly in ACL reeonstrt,etion using LARS artificial ligaments. This may be associated with speeifle features and different graft fixation of LARS artifieial ligament.