前交叉韧带重建术移植物止点对术后膝关节屈伸活动影响的临床研究

The Clinical Study on the Relation of the Attachment of Grafts to the Range of Knee Movement after Anterior Cruciate Ligament Reconstruction

目的 :通过研究移植物止点对术后膝关节屈伸活动的影响 ,寻求前交叉韧带重建中移植物在股骨和胫骨上的最佳止点。方法 :对 39例关节镜下前交叉韧带重建术后的病人摄膝关节正侧位片 ,测量移植物止点的位置。以术后 3周膝关节的主动活动度进行分组。结果 :①术后 3周有 30例病人主动屈曲达 90° ,其股骨止点位于Blumensaat’s线后 15 .6 2～ 48.48% (平均 31.5 1% ) ;未达 90°的 9例病人的止点位于 2 9.0 3～ 75 .76 % (平均 5 7.32 % ) ,两组比较差异显著 (P <0 .0 0 1)。②术后 3周有 7例主动伸直未达 0°,其胫骨止点位于胫骨平台的前 18.87～ 34.5 0 % (平均 2 4.14% ) ,32例伸直达 0°者的止点位于 2 5 .81～ 44 .83% (平均 36 .0 3% ) ,两组比较差异显著 (P <0 .0 0 1)。结论 :术后膝关节的屈曲功能与移植物的上止点关系密切 ,伸直与下止点相关。最佳股骨止点位于Blumensaat’s线后 2 0～ 40 % ,髁间窝顶点的外侧部 ;胫骨止点位于胫骨平台的前 30～ 40 % ,两个髁间棘之间。

Objective The aim of the study was to explore the relationship between active range of movement (ROM) and the attachment of graft, and seek for the right location of attachment of the graft at the femoral condyle and the tibial plateau during the anterior cruciate ligament (ACL) reconstruction. Methods From November of 1999 to April of 2000, the location of graft attachment on roentgenogram was measured in 39 patients with arthroscopy assisted bone-patellar tendon-bone ACL reconstruction. These patients were divided into subgroups according to the active ROM of knee three weeks after surgery. Results: (1) The active flexion reaching 90° three weeks after surgery was found in 30 patients, whose femoral attachments of ACL were positioned at 31.51% (ranged 15.62%～48.48%) from the posterior end of Blumensaat's line. Flexion less than 90° was seen in the remaining 9 patients, whose femoral attachments of ACL were positioned at 57.32% (ranged 29.03%-75.76%) from the posterior end of the Blumensaat's line. There was significant difference between these two groups (p<0.001). (2) Unable fully extension of knee (greater than 0°) was found in 7 patients, whose tibial attachments of ACL were positioned at front 24.14% (ranged 18.87%～34.50%) of the tibial plateau. Fully extension of knee was revealed in the remaining 32 patients, whose tibial attachments of ACL were positioned at front 36.03% (ranged 25.81%～44.83%) of the tibial plateau. There was also significant difference between these two groups (p<0.001). Conclusion After surgery, active flexion of knee was highly related to the attachment of graft on femoral condyle, while active extension of knee was highly related to the attachment of graft on tibial plateau. The best femoral attachment was located on 20%-40% from the posterior end of the Blumensaat's line and on lateral portion of the top of intercondylar fossa. The best tibial attachment was located on the front 30%～40% of the tibial plateau between two intercondylar eminences.