前十字韧带单束重建中前内侧与辅助前内侧入口创建股骨隧道的初期疗效比较

Comparison of anteromedial portal technique and accessory anteromedial portal technique for femoral tunnel drilling in single-bundle anterior cruciate ligament reconstruction

目的比较关节镜下行前十字韧带（anteriorcruciateligament，ACL）单束重建过程中采用前内侧人口与辅助前内侧人口创建股骨隧道的初期临床疗效。方法回顾性分析2012年3月至2014年2月采用自体半腱肌肌腱、股薄肌肌腱行ACL单束重建治疗单纯ACL完全断裂并获得完整随访的患者资料。根据创建股骨隧道时采用的入口方式，将患者分为前内侧入口组[14例，男8例，女6例；年龄19—60岁，平均（35．14±11．85）岁；受伤至手术时间（14．57±15。83）d；合并半月板损伤Stoller分级：0度1例，Ⅰ度3例，Ⅱ度10例]与辅助前内侧入口组[23例，男10例，女13例；年龄18～62岁，平均（39．78±12．72）岁；受伤至手术时间（14．70±15．25）d；合并半月板损伤Stoller分级：0度2例，Ⅰ度5例，Ⅱ度16例]。末次随访时采用Lysholm、Tegner和IKDC评分系统评价膝关节功能，并通过Lachman试验及Pivot-shift试验评价膝关节前后及旋转稳定性。结果两组患者均全部获得随访，前内侧人口组平均随访（16．07±7．31）个月，辅助前内侧入口组平均随访（13．35±5．92）个月。末次随访时，Lysholm、Tegner、IKDC评分：前内侧入口组分别为（89．86±7．90）分、（8．64±1．65）分、（89．31±8．16）分，辅助前内侧入口组分别为（92．17±6．72）分、（8．91±1．16）分、（90．89±7．80）分。Lachman试验：前内侧入口组11例阴性，3例阳性，阴性率为78．6％（11／14）；辅助前内侧人口组20例阴性，3例阳性，阴性率为87．0％（20／23）。Pivotshift试验：前内侧人口组9例阴性，5例阳性，阴性率为64．3％（9／14）；辅助前内侧入口组20例阴性，3例阳性，阴性率为87．0％（20／23）。两组患者术后末次随访Lysholm、Tegner、IKDC评分以及Laehman试验、Pivot-shift试验阴性率比较，差异均无统计学意义。结论关节镜下行膝关节ACL单束重建时，应用前内侧人口与辅助前内侧人口创建股骨隧道，术后均可取得优良的初期临床疗效。

Objective To compare the primary clinical results of the anteromedial portal （AMP） and accessory anterome- dial portal （AAMP） techniques for femoral tunnel drilling in single-bundle anterior cruciate ligament （ACL） reconstruction. Meth- ods Data of isolated ACL rupture patients who had undergone single-bundle ACL reconstruction with autologous semitendinosus and gracilis tendons from March of 2012 to February of 2014 were retrospectively analyzed. The femoral tunnels were drilled with AMP techniques in 14 patients （group AMP） and with AAMP techniques in 23 patients （group AAMP）. All the patients were followed up for 6 to 29 months. At the latest follow-up the Lysholm, Tegner and international knee documentation committee （IKDC） scores were used to estimate knee joint function, while the Laehman test and Pivot-shift test were used to estimate knee joint insta- bility. Results The average follow-up time was 16.07±7.31 months in group AMP and 13.35±5.92 months in group AAMP. In group AMP, the Lysholm, Tegner and IKDC average scores were 89.86±7.90, 8.64±1.65 and 89.31±8.16, respectively. While they were 92.17±6.72, 8.91±1.16 and 90.89±7.80 in group AAMP, respectively. In group AMP the Lachman test was negative in 11 pa- tients and positive in 3 patients. In group AAMP the Lachman test was negative in 20 patients and positive in 3 patients. The Pivot- shift test was negative in 9 patients, positive in 5 patients and negative in 20 patients, positive in 3 patients in group AMP and AAMP, respectively. There were no significant differences in Lysholm, Tegner, IKDC scores, the negative rates of Lachman and Pivot-shift tests between two groups. Conclusion Single-bundle ACL reconstructions using AMP and AAMP techniques for femo- ral tunnel drilling have similar excellent primary clinical results.