经胫骨低位骨隧道联合减张线改良后交叉韧带重建术的临床疗效

Effectiveness of lower tibial tunnel placement combined with internal tension relieving suture in posterior cruciate ligament reconstruction

目的比较经胫骨低位骨隧道联合减张线改良后交叉韧带(posterior cruciate ligament,PCL)重建与单纯经胫骨低位骨隧道PCL重建治疗PCL损伤的临床疗效。方法回顾分析2014年1月—2022年2月收治且符合选择标准的83例单纯PCL损伤患者临床资料。其中44例采用经胫骨低位骨隧道联合减张线改良重建PCL(减张线组),39例采用单纯经胫骨低位骨隧道重建PCL(对照组)。两组患者性别、年龄、身体质量指数、手术侧别、致伤原因及术前胫骨后移双侧差异(side-to-side difference,SSD)、疼痛视觉模拟评分(VAS)、膝关节活动度(range of motion,ROM)、Tegner评分、Lysholm评分和国际膝关节文献委员会(IKDC)评分(包括膝关节症状评分、日常活动评分、膝关节功能评分)等基线资料比较差异均无统计学意义(P>0.05)。记录并比较两组患者手术时间和术中出血量;采用术前及末次随访时Lysholm评分、IKDC各评分、Tegner评分、VAS评分、膝关节ROM、胫骨后移SSD以及末次随访时患者满意度评价临床疗效;采用MRI评估术后移植物恢复情况。结果两组患者手术时间和术中出血量比较差异均无统计学意义(P>0.05)。所有患者均获随访,随访时间12~60个月,两组随访时间比较差异无统计学意义(P>0.05)。术后两组患者MRI均显示移植物情况良好,重建PCL移植物信号好,连续性及张力好。随访期间两组均未出现再断裂、移植物供区不适等相关并发症。末次随访时,两组Lysholm评分、IKDC各评分、Tegner评分、VAS评分、膝关节ROM及胫骨后移SSD均较术前显著改善,差异有统计学意义(P<0.05)。减张线组Lysholm评分、Tegner评分、IKDC膝关节症状评分及SSD手术前后变化值优于对照组,差异有统计学意义(P<0.05);而两组VAS评分、膝关节ROM、IKDC日常活动评分和膝关节功能评分手术前后变化值及满意度评分比较差异无统计学意义(P>0.05)。结论与单纯经胫骨低位骨隧道重建PCL相比,经胫骨低位骨隧道联合减张线改良PCL重建能有效改善重建术后PCL再松弛,膝关节功能恢复更好。

Objective To compare the effectiveness between lower tibial tunnel placement combined with internal tension relieving suture and simple lower tibial tunnel placement for posterior cruciate ligament(PCL)reconstruction.Methods The clinical data of 83 patients with simple PCL injury who met the selection criteria between January 2014 and February 2022 were retrospectively analyzed.Among them,44 patients underwent PCL reconstruction through lower tibial tunnel placement combined with internal tension relieving suture(tension relieving suture group),and 39 patients underwent PCL reconstruction through simple lower tibial tunnel placement(control group).Baseline characteristics,including gender,age,body mass index,side of injury,cause of injury,preoperative side-to-side difference(SSD)in posterior tibial translation,visual analogue scale(VAS)score,knee range of motion(ROM),Tegner score,Lysholm score,and International Knee Documentation Committee(IKDC)scores(including symptom,daily activities,and knee function scores)were compared between the two groups,showing no significant difference(P>0.05).The operation time and intraoperative blood loss were recorded and compared between the two groups.The effectiveness was evaluated by Lysholm score,IKDC scores,Tegner score,VAS score,knee ROM,SSD in posterior tibial translation before operation and at last follow-up,the patient satisfaction at last follow-up,and the postoperative graft recovery was evaluated by MRI.Results There was no significant difference in operation time and intraoperative blood loss between the two groups(P>0.05).All patients were followed up 12-60 months,and there was no significant difference between the two groups(P>0.05).Postoperative MRI showed that the graft was in good condition,and the reconstructed PCL graft had good signal,continuity,and tension.During the follow-up,there was no complication such as re-rupture or donor site discomfort in both groups.At last follow-up,the Lysholm score,IKDC scores,Tegner score,VAS score,knee ROM,and SSD in posterior tibial translation significantly improved in both groups when compared with those before operation(P<0.05).The changes of Lysholm score,Tegner score,IKDC knee symptom score,and SSD in posterior tibial translation between pre-and post-operation were significantly superior in the tension relieving suture group compared to the control group(P<0.05).However,no significant difference was found between the two groups in the changes of VAS score,knee ROM,IKDC daily activities score or knee function score between pre-and post-operation,and the satisfaction score(P>0.05).Conclusion Lower tibial tunnel placement combined with internal tension relieving suture PCL reconstruction represents a more effective surgical approach for improving postoperative laxity of PCL and knee function recovery comparing to simple lower tibial tunnel placement PCL reconstruction.