前十字韧带股骨直接纤维止点重建的力学特征及近期临床疗效

The mechanical characteristics and early-stage clinical effects of double bundle anterior cruciate ligament reconstruction with femoral direct fiber insertion

目的探讨前十字韧带(anterior cruciate ligament,ACL)股骨直接纤维止点重建的有限元特征及近期疗效。方法2016年6月至2017年6月接受ACL股骨直接纤维止点双束重建的患者26例,男15例,女11例;年龄(30.5±4.6)岁(范围18~50岁)。所有患者均由同一医生完成自体腘绳肌腱股骨直接纤维止点双束ACL重建手术。通过术后有限元分析、术中Pivot shift试验及Lachman试验、手术前后国际膝关节文献委员会(International Knee Document Committee,IKDC)评分、Lyshlom评分、KT-2000侧侧差值、术后膝关节CT三维重建、膝关节MRI评估膝关节的稳定性、移植物的状态及临床疗效。结果有限元分析中髌骨应力集中在髌尖区域,健侧最大值为(1.62±0.07)MPa、患侧最大值为(1.64±0.02)MPa,差异无统计学意义(t=-1.22,P=1.22);股骨滑车区域应力集中在上极,健侧最大值为(0.73±0.15)MPa、患侧最大值为(0.72±0.14)MPa,差异无统计学意义(t=0.09,P=0.93)。重建后即刻Pivot shift试验均转为阴性,Lachman试验1例Ⅰ度阳性、其余均为阴性。术后CT三维重建示股骨隧道位于ACL股骨止点直接纤维足印区,术后2年MRI矢状面抑脂像示ACL双束呈均匀低信号、连续性及走行良好。Lysholm评分由术前(56.5±3.6)分增加至术后3个月的(61.9±3.2)分、术后2年的(88.5±2.0)分,差异有统计学意义(F=824.72,P<0.001);IKDC评分由术前(48.3±2.8)分增加至术后3个月的(58.0±2.0)分、术后2年的(92.5±2.6)分,差异有统计学意义(F=2256.66,P<0.001);KT-2000侧侧差值由术前(5.6±0.7)mm降低至术后3个月的(1.6±0.5)mm、术后2年的(1.5±0.6)mm,差异有统计学意义(F=389.14,P<0.001)。结论ACL股骨直接纤维止点双束重建能有效恢复膝关节的稳定性及力学环境,具有较好的近期临床疗效。

Objective To investigate the finite element analysis and early-stage clinical effects of double bundle anterior cruciate ligament(ACL)reconstruction with femoral direct fiber insertion.Methods From June 2016 to June 2017,a total of 26 cases of ACL reconstruction were analyzed retrospectively,including 15 males and 11 females,mean age 30.5±4.6 years.All the patients underwent ACL reconstruction by the same operator.The early-stage clinical effects were evaluated by the finite element analysis,pivot shift test,Lachman test,preoperative and postoperative IKDC score,Lyshlom score,KT-2000,3D-CT and MRI.Results The finite element analysis confirmed theoretically that the double bundle ACL reconstruction with femoral direct fiber insertion could restore the stability and biomechanics of knee effectively.The results of pivot shift test were negative,and the Lachman test were negative except one first-stage positive after operation.3D-CT showed that the bone tunnel was located in the direct fiber area.MRI showed clearly the ACL of double bundle after operation.Lysholm score increased from 56.5±3.6 pre-operation to 61.9±3.2 at three months after operation,and up to 88.5±2.0 two years after operation with statistically significant difference(F=824.72,P<0.001).IKDC score increased from 48.3±2.8 before operation to 58.0±2.0 at three months after operation,and to 92.5±2.6 at two years after operation with statistically significant difference(F=2256.66,P<0.001).KT-2000 side-side difference decreased from 5.6±0.7 mm to 1.6±0.5 mm at three months after operation,and to 1.5±0.6 mm at two years after operation with statistically significant difference(F=389.14,P<0.001).Conclusion The double bundle ACL reconstruction with femoral direct fiber insertion can effectively restore the stability and the biomechanical environment of knee joint with satisfied early-stage clinical effects.