后交叉韧带重建术后股骨隧道扩大与临床疗效的关系

Relationship between femoral tunnel enlargement after posterior cruciate ligament reconstruction and clinical outcome

目的 探讨同种异体肌腱重建后交叉韧带（PCL）术后股骨隧道扩大对临床疗效的影响.方法 32例同种异体胫前肌腱单束重建PCL患者,应用MRI分别测量术后1,3,12个月股骨隧道横截面的面积及隧道角度,采用Lysholm评分和KT-1000值评价膝关节功能.结果 隧道扩大率为34.4％（11/32）,1级6例,2级5例,Lysholm评分（93.2±3.6）分,其中0级（94.2±2.6）分,1级（93.7±3.1）分,2级（91.2±2.8）分;股骨隧道0级与2级之间比较差异有统计学意义（P＜0.05）,而0级与1级,1级与2级比较差异无统计学意义（P＞ 0.05）;KT-1000值（1.4±0.6） mm,其中0级（1.2±0.8）mm,1级（1.3±0.5） mm,2级（1.5±0.3） mm;股骨隧道0级与1级比较差异无统计学意义（P＞0.05）;而2级与0,1级比较差异有统计学意义（P＜0.05）.结论 同种异体肌腱重建PCL术后股骨隧道有不同程度扩大,股骨隧道扩大会影响膝关节的功能,合适的股骨隧道角度有助于减少股骨隧道扩大的发生.

Objective To investigate the effect of femoral tunnel enlargement after posterior cruciate ligament （PCL） reconstruction with tendon allograft on clinical outcome.Methods Thirty-two patients who accepted PCL reconstruction with tendon allograft,MRI examinations was used to measure the cross-sectional area of the femoral tunnel and tunnel angle on postoperative 1 month,3 months,12 months,the Lysholm score and KT-1000 value were used to evaluate the function of the knee.Results The tunnel enlargement rate was 34.4% （11/32）,grade 1 in 6 cases,grade 2 in 5 cases,Lysholm score average of （93.2 ± 3.6） scores,including grade 0 （94.2 ± 2.6） scores,grade 1 （93.7 ± 3.1） scores,grade 2 （91.2 ± 2.8） scores,there was significant difference between femoral tunnel of grade 0 and grade 2 （P 〈 0.05）,but grade 0 and grade 1,grade 1 and grade 2 had no significant difference （P〉 0.05）.KT-1000 average value was （1.4 ± 0.6） mm,including grade 0（1.2 ± 0.8） mm,grade 1 （1.3 ± 0.5） mm,grade 2 （1.5 ± 0.3） mm,there was no significant difference between femoral tunnel of grade 0 and grade 1 （P 〉 0.05）,but grade 2 and grade 0,grade 2 and grade 1 had significant difference （P 〈0.05）.Conclusions Femoral tunnel has different degrees of enlargement after PCL reconstruction with tendon allograft,bone tunnel enlargement has significant effect on functional of the knee,appropriate angle of bone tunnel expansion helps to reduce the incidence of bone tunnel.