前交叉韧带重建中不同入路制备股骨骨道的对比研究

Comparison of Two Femoral Tunnel Drilling Techniques in the Anterior Cruciate Ligament Reconstruction

目的:比较改良经胫骨隧道(TT)入路和前内侧(AM)入路两种方法解剖位重建前交叉韧带(ACL)术后,股骨隧道的定位情况及临床疗效。方法:回顾性分析2016年1月~2017年12月我科收治的42例单侧前交叉韧带损伤患者的临床资料。其中24例采用改良TT入路技术重建ACL,18例采用AM入路技术重建ACL。术后1周内行膝关节CT平扫+三维重建评估股骨骨道位置,术后3个月时扫描MRI并测量JGS、JGC角;术前及术后12个月评估患者国际膝关节文献委员会(IKDC)评分、Lysholm评分、膝关节前方松弛度及轴移试验结果。结果:术前两组患者性别、年龄、病程、IKDC评分、Lysholm评分、膝关节前方松弛度、轴移试验阴性率,差异均无统计学意义(P>0.05)。末次随访时,两组患者IKDC评分、Lysholm评分,前方松弛度,轴移试验阴性率相较术前均显著改善,差异具有统计学意义(P<0.05);组间比较,差异无统计学意义(P>0.05)。CT三维重建分析显示,两组股骨骨道内口位置无明显差异(P>0.05),MRI测量JGS、JGC角,组间无明显差异(P>0.05)。结论:采用改良经胫骨隧道入路和前内侧入路重建ACL,均可获得良好的股骨解剖中心隧道定位,骨道位置无明显差异,术后早期疗效令人满意。

Objectives To compare the femoral tunnel position and clinical outcomes of anterior cru ciate ligament(ACL)reconstruction with the modified tibiofibular tunnel(TT)portal and anterior medial(AM)portal.Methods Forty-two patients with unilateral anterior cruciate ligament injury in year 2016 and 2017 and treated in our department,were retrospectively analyzed.The ACL of 24 cases was re constructed with the modified TT portal,while that the other 18 cases was done with the AM portal.Three-dimensional CT scan of the affected knee was conducted one week after the surgery to evaluate the femoral tunnel positioning.The angles between the joint line and the graft on the sagittal and coro nal view were measured three months after the surgery on the magnetic resonance imaging(MRI).Be fore and 12 months after the surgery,both groups were evaluated using the international knee litera ture committee(IKDC)score,Lysholm score,as well as the anterior laxity and axial shift test of the reconstructed knees.Results There were no significant differences between the two groups in the gen der,age,course of disease,IKDC score,Lysholm score,anterior knee laxity,and test negative rate of the axial shift before the surgery(P>0.05).Twelve months after the surgery,the average IKDC score,Lysholm score,anterior knee laxity,and axial shift test negative rate of both groups improved significantly compared with the preoperative data(P<0.05).However,no significant differences were ob served between the two groups(P>0.05).Three-dimensional CT showed that there was no significant dif ference in the positioning of the femoral tunnel between the two groups(P>0.05).Moreover,there were no significant differences of the JGS angle and JGC angle between the two groups according to MRI re sults(P>0.05).Conclusion ACL reconstruction with the modified TT approach and AM approach both can achieve good anatomical positioning of the femoral tunnel,without significant differences in the po sitioning of the femoral tunnel and with favorable outcomes in 12 months after ACL reconstruction.