前内侧入路解剖重建单束前交叉韧带的临床评估

Clinical outcomes in the single-bundle anterior cruciate ligament reconstruction using anteromedial portal technique

目的评估关节镜下经前内侧入路解剖重建单柬前交叉韧带（ACL）的位置、形态及临床效果。方法对25例ACL断裂患者在关节镜下经前内侧入路应用解剖重建技术行单束ACL重建术，移植物应用自体胭绳肌腱。术后行X线、MRI检查，了解骨道情况，观察移植物形态及张力，并与11例健侧膝关节的正常ACL进行对比。应用Lysholm评分系统评估膝关节功能。结果术后x线片显示股骨隧道内口位于髁间窝顶与股骨后缘皮质线交叉点前缘，胫骨隧道内口位于髁问窝顶后方。MRI显示所有重建ACL张力良好，ACL上倾角为50．82°±4．57°，胫骨平台止点至前缘距离与平台纵径比值为0．50±0．04，两项与对照组比较差异均无统计学意义（P〉0．05）。患者均获得随访，时间为13～44个月。Lysholm评分术后为92．20分±4．29分，明显高于术前的64．76分±7．16分（P〈0．01）。结论关节镜下经前内侧入路解剖重建ACL的位置及形态接近解剖结构，早中期临床效果满意。

Objective To assess the position and clinical outcomes of the reconstructed single：bundle anterior cruciate ligament （ACL） through anteromedial portal （AMP） techniques. Methods Arthroscopic single-bundle ACL reconstruction with autologous hamstring tendon was performed using AMP technique in 25 patients. The bone tunnel position, upward angle, tension of graft were measured from magnetic resonance imaging examination and plain radiographs, 11 healthy subjects were used as a control group. The clinical outcome was assessed by the Lysholm knee score. Results The lateral radiographs demonstrate the femoral tunnels were anterior to the intersection of the intercondylar roof and the femoral posterior cortex line, and the tibial tunnels were posterior to the slope of the intercondylar roof. The upward dip of ACL measured from MRI were 50.82°±4. 57° . The center of the bibial tunnel was located 0. 50 ± 0. 04 of the entire sagittal length of the tibial plateau from the anterior edge of the tibia, compared with the control group about the two terms data, there was not significant difference （P 〉 0. 05 ）. The follow-up period was 13 -44 months. The Lysholm score increased from 64. 76±7. 16 points to 92. 20 ±4. 29 points （P 〈0.01 ）. Conclusions ACL reconstruction through anteromedial portal technique is closer to anatomy reconstruction, which provides satisfactory radiological and early Clinical outcomes.