两种股骨隧道定位方法对前交叉韧带重建术后功能康复的影响

Effect of two kinds of femoral tiinnel placemeet on knee functional rehabilitation after anterior cruciatr ligament reconstruction

目的:探讨采用解剖足迹法和IDEAL定位法对前交叉韧带(ACL)重建术后膝关节功能康复的影响。方法:选取2019年1—12月在我院行ACL重建术的患者,手术前根据股骨隧道定位方法随机分为个体化解剖重建组(解剖组)和IDEAL重建组(IDEAL组)。记录术中移植物直径及并发症发生情况。术后定期随访,记录膝关节Lysholm评分、国际膝关节文献委员会(IKDC)膝关节评估表评分、Lachman试验结果、再手术情况及满意度。结果:所有患者均获得随访,随访时间25~30个月,平均(26±5.6)个月。术后3、12、24个月两组Lysholm评分、IKDC膝关节评估表评分均明显优于术前(P<0.001),组间比较差异无统计学意义(P>0.05);末次随访时两组Lachman阳性率差异无统计学意义(P>0.05);随访过程中两组患者均无再断裂及再手术;两组患者手术满意度分别为96.2%、92.3%,差异无统计学意义(P>0.05)。结论:解剖足迹法和IDEAL定位法ACL重建均能恢复患者膝关节功能及稳定性,两种股骨隧道定位方法对患者术后早期康复无明显影响。

Objective: To investigate the effect of anatomical footprint procedure and IDEAL positioning procedure on functional rehabilitation after anterior cruciate ligament(ACL) reconstruction. Methods: Patients who underwent ACL reconstruction in Zhongda Hospital from January 2019 to December 2019 were selected and randomly assigned to individual anatomical reconstruction group(anatomical group) and IDEAL reconstruction group(IDEAL group) according to femoral tunnel placement at ACL reconstruction preoperatively. Graft diameter and complications were recorded during the operation. The patients were followed up at regular intervals postoperatively. Lysholms score, IKDC score, Lachman test, reoperation and satisfaction of patients were documented at the last follow-up. Results: All the patients were followed up for 25-30 months, with an average of(26±5.6) months. Postoperative Lysholm scores and IKDC scores of both groups at 3, 12 and 24 months were significantly higher than those before operation(P<0.001). There was no significantly statistical difference between the two groups(P>0.05). The results of the last follow-up showed that there was no statistical difference in the positive rate of Lachman test between the two groups(P>0.05).No re-tear of ACL and re-operation were found in both groups. The satisfaction rate of the two groups was 96.2% and 92.3% with no statistical difference(P>0.05). Conclusion: Both anatomical footprint procedure and IDEAL positioning procedure for anterior cruciate ligament reconstruction can improve the knee joint function and stability significantly. Two tunnel positioning procedures have no significant effect on postoperative rehabilitation.