前交叉韧带重建中股骨隧道过短者的临床疗效

Clinical results of arthroscopic anterior cruciate ligament reconstruction with short femoral tunnel

目的:观察前交叉韧带重建中股骨隧道过短者的临床疗效。方法:自2013年5月至2017年6月,采用Transportal技术单束重建前交叉韧带128例,其中32例出现股骨隧道过短纳入本组。男13例,女19例;年龄25.8(17~43)岁;病史(4.5±1.1)个月。在关节镜下以自体腘绳肌腱Transportal技术单束重建前交叉韧带。术后观察患者症状体征变化,测量患者胫骨前移度,并以Lysholm评分和Tegner评分评价膝关节术后功能。结果:经CT测量,32例患者股骨隧道长度为(27.34±0.36)mm。所有患者术后获2年以上随访。终末随访时,32例患者术膝轴移试验阴性30例,阳性2例;Lachman征阴性28例,Ⅰ度阳性4例;前抽屉试验阴性30例,Ⅰ度阳性1例,Ⅱ度阳性1例。胫骨前移度比健侧增加(2.6±1.8)mm,与术前比较差异有统计学意义(t=19.77,P<0.05)。Lysholm评分(82.2±6.1)分,与术前比较差异有统计学意义(t=17.33,P=0.001);Lysholm评分优15例,良10例,中7例,差0例,与术前比较差异有统计学意义(z=-7.151,P<0.05)。Tegner运动功能评分(7.4±0.6)分,与术前比较差异有统计学意义(t=9.11,P=0.0005)。术后患者膝关节运动能力明显提高,12例能参加对抗性体育运动,15例能参加非对抗性运动。15例对疗效非常满意,13例对疗效满意。结论:采用Transportal技术单束重建前交叉韧带发生股骨隧道过短的发生率为25%,目前临床观察短隧道患者的临床疗效尚可接受。但由于缺乏对照研究,隧道过短对疗效的影响作用尚不明确。

Objective:To evaluate the clinical outcome of arthroscopic reconstruction of anterior cruciate ligament(ACL)with short femoral tunnel.Methods:From May 2013 to June 2017,128 patients with anterior cruciate ligament reconstruction were performed with Transportal technique.Among them,32 cases had short femoral tunnel were included,including 13 males and 19 females,aged 25.8(17 to 43)years old,with a mean history of(4.5±1.1)months.The tibial tunnels were drilled in the middle of the footprint of the ACL,and femoral tunnels were drilled by transportal technique.Grafts were fixed with Endobutton at the femoral side and with interference screw at the tibial side.The changes of symptoms and signs were observed and the anterior tibial displacement was measured.The function of knee joint was evaluated by Lysholm score and Tegner score.Results:All patients were followed up for over 2 years.At the latest follow-up,30 patients were negative and 2 patients were positive in knee shift test;28 patients were negative in Lachman sign,4 patients were positive in degreeⅠ;30 patients were negative in anterior drawer test,1 patient was positive in degreeⅠand 1 patient was positive in degreeⅡ.The anterior displacement of the tibia increased by(2.6±1.8)mm compared with the healthy side,which was significantly different from that before operation(t=19.77,P<0.05).Lysholm score of 82.2±6.1 was significantly higher than that before operation(t=17.33,P=0.001).According to Lysholm score evaluation,15 cases got an excellent result,10 were good,7 were fair,and no bad results,with a significant difference compared with that before operation(z=-7.151,P<0.05).Tegner motor function score of(7.4±0.6)was significantly different from that before operation(t=9.11,P=0.0005).After operation,the knee joint movement ability of the patients improved significantly.Twelve patients could participate in antagonistic sports and 15 patients could participate in non-antagonistic sports.Fifteen patients were very satisfied with the curative effect,13 patients were satisfied with the curative effect.Conclusion:The incidence of short femoral tunnel in anterior cruciate ligament reconstruction with transportal technique is 25%.At present,the clinical effect of patients with short tunnel is acceptable.However,due to the lack of comparative study,the effect of short tunnel on the curative effect is still unclear.