不同固定方法重建前交叉韧带后骨道变化的对比临床观察研究  

Comparative Study of Tunnel Expansion after Anterior Cruciate Ligament Reconstruction with Different Fixation in Tibia

作　　者：王健[1] 敖英芳[1] 

机构地区：[1]北京大学第三医院运动医学研究所,北京100083

出　　处：《中国运动医学杂志》2007年第4期438-443,共6页Chinese Journal of Sports Medicine

摘　　要：目的：对比研究胫骨端不同固定方法采用半腱肌腱和股薄肌腱重建前交叉韧带后骨道增宽情况。材料和方法：我所2005年3月到12月的64名患者（65例膝关节）单束前交叉韧带重建患者，采用自体半腱肌腱和股薄肌腱为移植物，根据胫骨端固定方法不同分为门形钉组（36例），联合固定组（可吸收挤压螺钉＋门形钉，14例），Intrafix组（Intrafix固定螺钉，15例），术后平均15．8个月（11．20个月）随访时拍x线片进行骨道测量，股骨端测量骨道关节入口处直径，胫骨端分别测量胫骨骨道关节线水平（T1）、骨道中点部位（亿），及骨道胫骨皮质出口处（r13），取胫骨骨道最宽处作为衡量骨道增宽的标准，所得数据进行统计分析。结果：门形钉组、联合固定组和Intrafix组三组股骨骨道增宽发生率，正位分别为97．22％、92．86％、93．33％，侧位为94．44％、85．71％、93．33％，胫骨骨道增宽发生率，正位为91．67％、92．86％、93．33％，侧位为91．67％、92．86％、100％。各组股骨、胫骨骨道增宽发生率相比无明显差别。门形钉组、联合固定组和Intrafix组三组骨道增宽程度，股骨正位分别为55．71％、47．60％、56．40，侧位为55．52％、53．00％、51．30％；胫骨正位为47．14％、52．60％、66．20％，侧位为51．85％、63．50％、72．50％。胫骨骨道形状以O型（正位片）及v型（侧位片）最常见。Intrafix组术后随访时胫骨骨道关节入口处骨道扩大不明显，和术后即刻相比此处直径正位片上无明显差别，侧位片上仅1例骨道扩大超过2mm。结论：术后随访时门形钉组、联合固定组和Intrafix组三组骨道增宽发生率无明显差别。Intrafix组胫骨骨道关节入口处增宽不明显。Objective To investigate the size of and the change in bone tunnel after arthroscopic assisted anterior cruciate ligament （ACL） reconstruction, evaluate the incidence, morphology of the bone tunnel expansion, and analyze the relation of the bone tunnel expansion to the techniques of fixation. Methods From March to December of 2005, 64 cases （65 knees） of arthroscopic ACL reconstruction were performed in our institute and were followed up for an average of 15.8 months （11 to 20 months）. According to tibial fixation technique, they were divided into 3 groups： group A with staple; group B with staple and bioabsorbable interference screw; and group C with Intrafix. The diameter and the shape of bone tunnel were measured using X - ray. X - ray of all cases in group C was taken immediately after reconstruction to measure diameter of bone tunnel. Results The incidence of femoral tunnel expansion after ACL reconstruction in groups A, B and C was 97.22%, 92.86% and 93.33%, respectively, in the A- P X- ray view, and 94.d4%, 85.71% and 93.33 %, respectively, in the lateral X - ray view. The incidence of tibial tunnel expansion after ACL recon- struction in groups A, B and C was 91.67%, 92.86% and 93.33%, respectively, in the A - P X - ray view, and 91.67%, 92.86% and 100%, respectively, in the lateral X- ray view . There was no difference in the incidence of tunnel expansion among the 3 groups. The extent of femoral tunnel expansion in groups A, B and C was 55.71%, 47.60% and 56.40%, respectively in the A - P X - ray view, and 55.52%, 53.00% and 51.30%, respectively in lateral X - ray view. The extent of tibial tunnel expansion in groups A, B and C was 47.14%, 52.60% and 66.20%, respectively in the A - P X - ray view, and 51.85%, 63.50% and 72.50%, respectively in lateral X - ray view. The most common tibial tunnel was in 0 shape in the A - P X - ray view and V shape in the lateral X - ray view. In group C, 14 tibial tunnels in the lateral X - ray view were in 0 shape. Tibial tunnel expansion existed immediate

关 键 词：膝关节 前交叉韧带重建 胭绳肌腱 骨道增宽 

分 类 号：R687[医药卫生—骨科学]