摘要
目的比较关节镜下“4”字体位与传统高屈膝体位制备股骨骨道行自体肌腱移植重建前交叉韧带(ACL)的疗效。方法采用回顾性队列研究分析2019年8月至2019年10月哈尔滨医科大学附属第二医院收治的46例ACL损伤患者的临床资料,其中男26例,女20例;年龄24~40岁[(31.1±7.5)岁]。患者均行关节镜下自体肌腱移植重建ACL。21例采用“4”字体位建立股骨骨道(“4”字体位组),25例采用传统高屈膝体位建立股骨骨道(高屈膝体位组)。比较两组手术时间。术后8周应用三维CT结合Bernard四分表格法评估和测量股骨骨道的中心位置、长度及角度。术前、术后8周及1年采用膝关节Lysholm评分评价膝关节功能。观察并发症情况。结果患者均获随访2~20个月[(15.3±2.1)个月]。“4”字体位组手术时间为(28.5±2.6)min,明显少于高屈膝体位组的(39.5±2.4)min(P<0.05)。“4”字体位组骨道中心位置位于Bernard四分表格法的(27.1±1.4)%和(25.1±2.6)%,高屈膝体位组骨道中心位置位于Bernard四分表格法的(28.1±2.8)%和(26.1±3.1)%(P均>0.05)。“4”字体位组骨道全长度为(42.1±2.4)mm,粗骨道长度为(34.1±2.4)mm,明显长于高屈膝体位组的(38.2±2.5)mm及(31.1±2.7)mm(P均<0.05)。“4”字体位组骨道冠状面角度为(41.1±2.4)°,明显小于高屈膝体位组的(47.5±2.6)°;“4”字体位组骨道矢状面角度为(42.1±1.4)°,明显大于高屈膝体位组的(37.1±1.8)°(P均<0.05)。术前、术后8周及1年“4”字体位组膝关节Lysholm评分分别为(53.4±5.2)分、(97.1±1.4)分、(98.3±2.3)分;高屈膝体位组分别为(54.3±7.4)分、(97.1±1.6)分、(98.1±1.3)分,两组差异无统计学意义(P均>0.05);两组术后8周及术后1年膝关节功能较术前明显改善(P均<0.05)。高屈膝体位组1例股骨骨道破裂,1例股骨内侧髁软骨损伤,1例外侧半月板后根损伤。“4”字体位组无上述并发症发生(P<0.05)。结论关节镜下“4”字体位与传统高屈膝体位制备股骨骨道行自体肌腱移植重建ACL均能促进膝关节功能恢复,但前者具有手术时间短、骨道长度和角度良好及并发症少等优势。
Objective To compare the efficacy of arthroscopic anterior cruciate ligament reconstruction using tendon autograft with figure-of-four position and traditional knee hyperflexed position for femoral tunnel creation.Methods A retrospective case series study was conducted to analyze the clinical data of 46 patients with ACL injury admitted to Second Affiliated Hospital of Harbin Medical University from August 2019 to October 2019,including 26 males and 20 females;aged 24-40 years[(31.1±7.5)years].All patients underwent arthroscopic ACL reconstruction using tendon autograft.The femoral tunnel was created with figure-of-four position in 21 patients(figure-of-four position group)and with traditional knee hyperflexed position in 25 patients(knee hyperflexed position group).The operation time was compared between the two groups.The center position,length and angle of femoral tunnel were evaluated and measured by three dimensional CT reconstruction and Bernard quadrant method at 8 weeks postoperatively.The knee function was assessed by knee Lysholm score preoperatively,at 8 weeks and at 1 year postoperatively.Complications were observed as well.Results All patients were followed up for 2-20 months[(15.3±2.1)months].The operation time was(28.5±2.6)minutes in figure-of-four position group,significantly less than(39.5±2.4)minutes in knee hyperflexed position group(P<0.05).The tunnel center position was located at(27.1±1.4)%and(25.1±2.6)%within the Bernard quadrant in figure-of-four position group,similar with(28.1±2.8)%and(26.1±3.1)%in knee hyperflexed position group(all P>0.05).Total tunnel length and thick tunnel length were(42.1±2.4)mm and(34.1±2.4)mm in figure-of-four position group,significantly longer than(38.2±2.5)mm and(31.1±2.7)mm in knee hyperflexed position group(all P<0.05).The coronal plane angle of the tunnel was(41.1±2.4)°in figure-of-four position group,significantly smaller than(47.5±2.6)°in knee hyperflexed position group(P<0.05).The sagittal plane angle of the tunnel was(42.1±1.4)°in figure-of-four position group,significantly greater than(37.1±1.8)°in knee hyperflexed position group(P<0.05).Figure-of-four position group showed the knee Lysholm score of(53.4±5.2)points preoperatively,(97.1±1.4)points at 8 weeks postoperatively and(98.3±2.3)points at 1 year postoperatively.Knee hyperflexed position group showed the knee Lysholm score of(54.3±7.4)points preoperatively,(97.1±1.6)points at 8 weeks postoperatively and(98.1±1.3)points at 1 year postoperatively.The knee Lysholm score did not differ significantly between the two groups(all P>0.05),but the knee function was significantly improved in both groups when compared with that before the operation(all P<0.05).There were 1 patient with femoral tunnel fracture,one with injury to the medial condylar cartilage and one with injury to the posterior root of lateral meniscus in knee hyperflexed position group,while no above-mentioned complications occurred in figure-of-four position group(P<0.05).Conclusion Arthroscopic ACL reconstruction using tendon autograft with femoral tunnel creation through figure-of-four position and traditional knee hyperflexed position can both contribute knee functional recovery,but the figure-of-four position has the advantages of short operation time,accurate tunnel positioning,favorable length and angle of the tunnel and less complications.
作者
薛震
秦勇
黄超
马欣楠
张刚
王洪伟
吕松岑
Xue Zhen;Qin Yong;Huang Chao;Ma Xinnan;Zhang Gang;Wang Hongwei;Lyu Songcen(Department of Sports Medicine and Minimally Invasive Surgery for Joint Diseases,Second Affiliated Hospital of Harbin Medical University,Harbin 150086,China;Department of Orthopedics,First Hospital of Harbin,Harbin 150001,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2022年第7期613-619,共7页
Chinese Journal of Trauma
关键词
膝损伤
前交叉韧带
移植
自体
股骨骨道
Knee injuries
Anterior cruciate ligament
Transplantation,autologous
Femoral tunnel
