前交叉韧带陈旧性损伤与新鲜损伤术后骨隧道直径及保残长度变化

Retrospective analysis of the changes of bone tunnel diameter and residual length after old injury and fresh injury of anterior cruciate ligament injury

目的研究陈旧性前交叉韧带损伤与新鲜损伤术后胫骨、股骨骨隧道的变化及保残长度的影响,并对其临床疗效进行评估。方法选取我院2020年1月至2021年1月收住的前交叉韧带损伤患者共计320例,分为新鲜损伤组(伤后3月内),陈旧性损伤组(距离受伤时间超过3月),每组患者160例;分别于不同时间段行CT检查,测量两组患者胫骨、股骨骨隧道变化,并对膝关节IKDC、Lysholm、Tenger评分情况、膝关节本体感觉恢复情况、核磁检查腱骨愈合情况。结果新鲜损伤组患者保残长度明显优于陈旧性损伤组(P<0.05);术后6个月时,两组患者胫骨、股骨骨隧道均有扩大,新鲜损伤组股骨骨隧道扩大程度小于陈旧损伤组(P<0.05),而两组胫骨骨隧道扩大比较差异无统计学意义(P>0.05);术后1年时,胫骨、股骨骨隧道同时扩大,新鲜损伤组骨隧道扩大程度明显小于陈旧损伤组(P<0.05)。新鲜损伤组IKDC、Lysholm、Tenger评分与陈旧性损伤组比较,新鲜损伤组明显优于陈旧损伤组(P<0.05);膝关节本体感觉在术后6月时两组比较差异无统计学意义(P>0.05),术后12个月时新鲜损伤组明显优于陈旧损伤组(P<0.05)。结论前交叉韧带早期重建(3个月内)能更好的保留残端,阻止胫骨股骨隧道扩大、恢复膝关节功能。

Objective To investigatey the changes of tibial and femoral bone tunnels and the influence of residual length after old anterior cruciate ligament injury and fresh injury,and to evaluate its clinical efficacy.Methods A total of 320 patients with anterior cruciate ligament injury admitted to our hospital from January 2020 to January 2021 were selected and assigned to fresh injury group(≤3 months after injury,n=160)and old injury group(>3 months after injury,n=160).CT was performed at different time periods.The changes of tibial and femoral bone tunnels in the two groups were measured,and the IKDC,Lysholm and Tenger scores of the knee joint,the recovery of knee proprioception and the healing of tendon and bone by nuclear magnetic resonance were monitored.Results The residual length of the fresh injury group was significantly better than that of the old injury group(P<0.05).At 6 months after operation,the tibial and femoral bone tunnels of the two groups were enlarged.The expansion of the femoral bone tunnel in the fresh injury group was smaller than that of the old injury group.There was a statistical difference between the two groups(P<0.05),but there was no statistical difference between the two groups(P>0.05).At 1 year after operation,the tibial and femoral bone tunnels were enlarged at the same time.The expansion of the bone tunnel in the fresh injury group was significantly smaller than that in the old injury group.There was a statistical difference between the groups(P<0.05).Compared with the old injury group,the IKDC,Lysholm and Tenger scores of the fresh injury group were significantly better than those of the old injury group(P<0.05).There was no significant difference in knee proprioception between the two groups at 6 months after operation(P>0.05).At 12 months after operation,the fresh injury group was significantly better than the old injury group.There was significant difference between the two groups(P<0.05).Conclusion Early anterior cruciate ligament reconstruction(≤3 months)could better preserve the stump,prevent the expansion of the tibial femoral tunnel and restore knee function.