透视辅助关节镜下前交叉韧带重建术的临床研究

Clinical research of anterior cruciate ligament reconstruction via arthroscopy assisted by fluoroscopy

目的探讨透视辅助关节镜下前交叉韧带(ACL)重建术的可行性和临床效果。方法选择60例拟行ACL重建术的患者,采用随机法分为2组,对照组(30例)使用传统关节镜手术重建ACL,透视组(30例)采用透视辅助关节镜下ACL重建术。比较两组患者的手术时间,出血量,术后侧位片骨隧道位点,手术前后的KT-2000分析结果(双膝前向松弛度差值)及分级情况、Lysholm膝关节功能评分、国际膝关节文献委员会(IKDC)评分,以及并发症的发生情况。结果透视组手术时间长于对照组,出血量多于对照组(均P<0.05)。透视组胫骨隧道位点为(46.32%±3.54%)、股骨隧道位点为(62.10%±2.66%),对照组胫骨隧道位点为(42.67%±6.41%)、股骨隧道位点为(57.48%±3.70%),两组比较差异有统计学意义(均P<0.05)。术后12个月,两组KT-2000分析结果(双膝前向松弛度差值)、Lysholm膝关节功能评分、IKDC评分显著优于术前,且透视组IKDC评分明显高于对照组(均P<0.05),而两组KT-2000分析结果(双膝前向松弛度差值)及分级情况、Lysholm膝关节功能评分比较,差异无统计学意义(均P>0.05)。两组均无神经管损伤、感染、下肢深静脉血栓形成、异位骨化、关节僵硬等并发症发生。结论透视辅助关节镜下ACL重建术是安全、可行的,效果较好。通过术前的规划、设计,可以使股骨、胫骨隧道位置更精确。

Objective To explore the feasibility and clinical effects of anterior cruciate ligament(ACL)reconstruction via arthroscopy assisted by fluoroscopy.Methods A total of 60 patients underwent elective ACL reconstruction were selected and assigned to two groups according to the random method.The control group(30 cases)employed conventional arthroscopic operation to reconstruct ACL,whereas the fluoroscopy group(30 cases)used ACL reconstruction via arthroscopy assisted by fluoroscopy.The operation duration,blood loss volume,postoperative lateral film of bone tunnel site,and pre-and post-operative analysis results of KT-2000(difference value of both knees forward relaxation degree)and classification status,Lysholm knee function score,International Knee Documentation Committee(IKDC)score,and prevalence of complication were compared between the two groups.Results The fluoroscopy group yielded longer operation duration,and more blood loss volume as compared with the control group(all P<0.05).Tibial tunnel site and femoral tunnel site were(46.32%±3.54%)and(62.10%±2.66%)in the fluoroscopy group,whereas(42.67%±6.41%)and(57.48%±3.70%)in the control group,respectively,and there were statistically significant differences between the two groups(all P<0.05).After 12 month of operation,both groups yielded superior analysis results of KT-2000(difference value of both knees forward relaxation degree),Lysholm knee function scores,IKDC scores to compare with before operation,and the score of IKDC was higher in the fluoroscopy group than in the control group(all P<0.05);however,there were no statistically significant differences in analysis results of KT-2000(difference value of both knees forward relaxation degree)and classification status,and Lysholm knee function scores between the two groups(all P>0.05).No complications such as neurovascular injury,infection,low extremity deep venous thrombosis,heterotopic ossification,and ankylosis occurred in the two groups.Conclusion ACL reconstruction via arthroscopy assisted by fluoroscopy is safe and feasible,with relatively good effects.Femoral and tibial tunnel sites can be more accurate according to preoperative planning and design.