由外向内与经胫骨建立股骨隧道保留残迹重建前交叉韧带的病例对照研究  

Case-control studies on therapeutic effects of arthroscopic reconstruction of anterior cruciate ligament with preservation of remnant through outside-in and transtibial tunel

作　　者：孙磊[1] 吴波[1] 罗永忠[1] 刘欣欣[1] 李岩[1] 

机构地区：[1]解放军第88医院全军骨科中心,山东泰安271000

出　　处：《中国骨伤》2013年第5期397-401,共5页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨关节镜下由外向内与经胫骨隧道建立股骨隧道保留残迹重建前交叉韧带(ACL)的临床效果。方法:自2005年6月至2012年1月,采用关节镜下保留残迹重建ACL145例,由外向内建立胫骨和股骨隧道88例(由外向内组),男55例,女33例,年龄18～52岁,平均(29.22±7.31)岁;经胫骨隧道建立股骨隧道57例(经胫骨组),男35例,女22例,年龄18～51岁,平均(29.28±8.07)岁。对两组术前、术后早期及随访时的Lysholm、VAS评分及IKDC分级等进行比较。结果:由外向内组手术时间(76.94±10.83)min,经胫骨组(70.35±10.11)min,经胫骨组手术时间短于由外向内组。两组术后早期关节积液反应差异无统计学意义(P=0.065)。随访18～60个月,两组患者的关节稳定性均较术前提高;由外向内组Lysholm评分由术前54.75±10.58,增加至随访时95.80±5.16;经胫骨组Lysholm评分由术前52.51±11.38,增加至随访时94.86±5.50;此外,两组IKDC评级均较术前有显著改善。随访时两组间比较,轴移试验、Lachman试验和前抽屉试验的稳定性差异无统计学意义,Lysholm评分和IKDC评级差异亦无统计学意义。结论:由外向内技术建立股骨隧道具有容易达到解剖位重建、对关节内干扰小的优点,但技术操作较复杂。而经胫骨技术操作方便,手术时间较短。依据实际情况选择相应的任何一种技术方法,均能取得满意的临床效果。Objective：To compare the properties and clinical outcomes of arthroscopic reconstruction of anterior eruci- ate ligament （ACL） with preservation of remnant through outside-in and transtibial tunel. Methods：From June 2005 to Jan- uary 2012,145 patients were treated with arthroscopic reconstruction of ACL with preservation of remnant. Among the pa- tients, 88 patients were treated with outside-in techniques （outside-in group）,including 55 males and 33 females, ranging in age from 18 to 52 years,with a mean of （29.22 ±7.31 ） years; 57 patients were treated with transtibial technique （transtibial group）,including 35 males and 22 females,ranging in age from 18 to 51 years,with a mean of （29.28±8.07）years. The Lysholm, VAS and IKDC scores were compared between two groups before operation, after operation and at the latest follow- up time. Results： The average operation time was （76.94± 10.83 ） rain in the outside-in group, and （70.35± 10.11 ） rain in the transbibial group, there was a significant difference between two groups. There was no significant difference of hydrops arti- culi scores at the early stage between the two groups （P=0.065）. At follow-up from 18 to 60 months,there were great im- provements in the knee stabilities in each group compared with the preoperative data respectively. The Lysholm score im- proved from 54.75±10.58 preoperatively to 95.80±5.16 at the follow-up in the outside-in group; and improved from 52.51± 11.38 preoperatively to 94.86±5.50 at follow-up in the transtibial group. Additionally,IKDC grades also improved in both groups. However,no significant differences were seen in stabilities shown by pivot shift test,Lachman test and anterior drawer test. And there also no significant differences of Lysholm scores and IKDC grades between two groups after opera- tion. Conclusion：The outside-in technique has advantages to create an anatomical femoral tunnel easily with minimal intra- articular interference, and disadvantages of complicated manipul

关 键 词：膝关节 前交叉韧带 修复外科手术 关节镜 病例对照研究 

分 类 号：R686.5[医药卫生—骨科学]