全内与传统隧道技术重建前十字韧带术后隧道扩大程度及疗效的比较

Comparative analysis of tunnel enlargement after reconstruction of the anterior cruciate ligament of the knee by all-inside versus conventional tunneling methods

目的比较采用全内技术与传统由外向内移植物引人技术重建前十字韧带(anteriorcruciateligament,ACL)术后隧道扩大程度及临床疗效。方法回顾性分析2021年12月至2022年7月中国科学技术大学附属第一医院收治前十字韧带损伤患者47例,根据重建ACL方式分为全内技术组和传统技术组。全内技术组25例,男18例、女7例,年龄(27.72±7.33)岁,左17例、右8例;传统技术组22例,男11例、女11例,年龄(27.82±7.12)岁,左11例、右11例。比较两组住院天数、手术时间、疼痛视觉模拟评分(visual analogue scale,VAS)、Lysholm评分、国际膝关节文献委员会(International KneeDocumentationCommittee,IKDC)评分及Tegner评分。通过术后1年CT扫描评估股骨与胫骨隧道扩大程度。结果所有患者均获得随访,随访时间(15.64±2.04)个月(范围12~21个月)。全内技术组手术时间为(178.60±42.90)min,长于传统技术组的(133.60±28.77)min(t=4.163,P<0.001)。全内技术组术后第1天、第15天VAS评分[(7.08±1.29)分、(5.56±1.33)分]均较传统技术组[(7.96±1.29)分、(6.32±1.13)分]低(P<0.05)。术后第1、6、12个月VAS评分两组差异无统计学意义(P>0.05)。全内技术组和传统技术组术前Lysholm、IKDC及Tegner评分分别为(34.00±18.63)分、(36.24±15.01)分、(1.20±1.12)分和(36.18±13.64)分、(38.23±14.94)分、(1.55±1.14)分,术后6个月分别为(72.60±13.95)分、(74.12±12.03)分、(3.56±1.05)分和(68.41±10.80)分、(66.59±17.93)分、(3.23±1.15)分,术后12个月分别为(92.32±5.23)分、(81.40±7.24)分、(5.28±1.62)分和(91.27±6.32)分、(82.18±7.26)分、(4.96±1.25)分。术后6个月两组功能均较术前改善(P<0.05),术后12个月进一步改善(P<0.05);两组间功能评分的差异均无统计学意义(P>0.05)。术后1年,全内技术组股骨及胫骨隧道扩大值为(1.78±1.03)mm和(1.18±0.97)mm,均小于传统技术组的(2.30±1.33)mm和(1.83±1.00)mm,差异有统计学意义(P<0.05)。传统技术组股骨侧隧道扩大与胫骨侧扩大差异无统计学意义(P>0.05),而全内技术组股骨侧扩大大于胫骨侧(P<0.05)。两组股骨侧及胫骨侧0级与1级隧道扩大的Lysholm、IKDC及Tegner评分的差异均无统计学意义(P>0.05)。结论全内与传统由外向内移植物引入技术行ACL重建术后短期临床疗效相当,但全内重建技术后早期疼痛较轻,且隧道扩大程度较小;骨隧道扩大程度对临床早期疗效无明显影响。

Objective To compare the postoperative tunnel enlargement and clinical outcomes of anterior cruciate liga-ment(ACL)reconstruction using the all-inside technique with the traditional outside-in graft introduction technique.MethodsA retrospective analysis was conducted on 47 patients with ACL injuries who were admitted to the First Hospital of the University of Science and Technology of China between December 2021 and July 2022.The patients were categorized into two groups based on the surgical approach used for ACL reconstruction.There were 25 cases in the all-inside group,18 males and 7 females,aged 27.72±7.33 years,17 cases on the left side and 8 cases on the right side;22 cases in the traditional group,11 males and 11 fe-males,aged 27.82±7.12 years,11 cases on the left side and 11 cases on the right side.Clinical parameters including the length of hospital stay,surgical duration,pain levels assessed via the visual analogue scale(VAS),Lysholm score,International Knee Docu-mentation Committee(IKDC)score,and Tegner score were recorded and compared between the two groups.Additionally,femoral and tibial tunnel enlargement was evaluated using postoperative CT scans conducted one year after surgery.ResultssAll patients were followed up for 15.64±2.04 months(range,12-21 months).The mean operation time was 178.60+42.90 min in the all-inside group and 133.60±28.77 min in the traditional group,indicating a statistically significant longer operation time in the all-inside group(P<0.05).On postoperative days 1 and 15,the VAS scores were lower in the all-inside group(7.08±1.29 and 5.56±1.33 points)compared to the conventional group(7.96±1.29 and 6.32±1.13 points),with a statistically significant difference(P<0.05).However,the differences in VAS scores between the two groups at postoperative months 1,6,and 12 were not statistically significant(P>0.05).The preoperative Lysholm,IKDC,and Tegner scores in the all-inside group and the conventional group were 34.00±18.63,36.24±15.01,1.20±1.12 points and 36.18±13.64,38.23±14.94,1.55±1.14 points,respectively,and at 6 months after surgery,respectively were 72.60±13.95,74.12±12.03,3.56±1.05 points,and 68.41±10.80,66.59±17.93,3.23±1.15 points,and at 12 months postoperatively were 92.32±5.23,81.40±7.24,5.28±1.62 points and 91.27±6.32,82.18±7.26,4.96±1.25 points.Both groups improved at 6 months postoperatively compared with preoperatively(P<0.05),and further improved at 12 months postoperatively compared with 6 months postoperatively(P<0.05),but the differences in each functional score between the two groups were not statistically significant at all time points(P>0.05).At 1 year postoperatively,the values of femoral and tibial tunnel enlargement in the all-inside group(1.78±1.03 mm,1.18±0.97 mm)were smaller than those in the conventional group(2.30±1.33 mm,1.83+1.00 mm),and the differences were statistically significant(P<0.05).The difference between the femoral side tunnel enlargement and tibial side enlargement in the traditional group was not statistically significant(P>0.05),while the femoral side enlargement in the all-inside group was significantly larger than the tibial side(P<0.05).The difference in Lysholm,IKDC and Tegner scores between grade O and grade 1 tunnel enlargement on the femoral side and tibial side was not statistically significant(P>O.05).Conclusion The short-term clinical outcomes following ACL reconstruction using the all-inside technique versus the traditional tunnel technique were comparable.However,early postoperative pain was less severe with the all-inside technique,and tunnel enlargement was smaller.The degree of bone tunnel enlargement did not significantly impact early clinical outcomes.