经不同入路Rigidfix重建前交叉韧带发生软骨损伤的比较研究  

COMPARATIVE STUDY ON CHONDRAL INJURIES VIA DIFFERENT APPROACHES TO RECONSTRUCT ANTERIOR CRUCIATE LIGAMENT USING Rigidfix FEMORAL FIXATION DEVICE

作　　者：黄长明[1,2] 范华强[1,2] 傅仰攀[1,2] 董辉详[1,2] 唐聪[1,2] 

机构地区：[1]解放军第174医院骨科 [2]厦门大学附属成功医院,福建厦门361003

出　　处：《中国修复重建外科杂志》2014年第6期677-680,共4页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：南京军区医学科技创新课题项目(08MA071)~~

摘　　要：目的解剖比较经前内侧入路及经胫骨隧道行Rigidfix横穿钉内固定系统重建前交叉韧带（anteriorcruciateligament，ACL）过程中，损伤股骨关节面软骨的可能性。方法将9具成人防腐尸体双膝关节标本配对分成2组（n=9），A组经前内侧入路，B组经胫骨隧道入路；均采用Rigidfix横穿钉内固定系统操作，分别于0、10、20、30、45、60、70、80、90。模拟ACL重建术，记录分析软骨损伤发生率与旋转角度的相关性，并比较两组股骨关节软骨损伤发生率。结果相关分析显示，A、B组软骨损伤发生率与角度变化成正相关（r=0．611，P=0．000；r=0．852，P=0．000）。A、B组软骨损伤发生率分别为69．1％（56／81）及48．1％（39／81），差异有统计学意义（X2=7．356，P=0．007）。分层分析结果提示，在0～30°范围，A组软骨损伤发生率为36．1％（13／36），显著高于B组（0）（x2=15．864，P=0．000）；45～90°范围，A、B组发生率分别为95．6％（43／45）及86．7％（39／45），比较差异无统计学意义（P=0．267）。结论与经胫骨隧道入路相比，使用Rigidfix横穿钉内固定系统行前内侧入路重建ACL，软骨损伤风险增加。Objective To compare the incidence of chondral injury using Rigidfix femoral fixation device via the anteromedial approach and the tibial tunnel approach during anterior cruciate ligament （ACL） reconstruction. Methods Eighteen adult cadaver knees were divided randomly into 2 groups, 9 knees in each group. Femoral tunnel drilling and cross-pin guide insertions were performed using the Rigidfix femoral fixation device through the anteromedial approach （group A） and the tibial tunnel approach （group B）. ACL reconstruction simulation was performed at 0, 10, 20, 30, 45, 60, 70, 80, and 90° in the horizontal position. The correlation between incidence of chondral injury and slope angles was analyzed, and then the incidence was compared between the 2 groups. Results The correlation analysis indicated that the chondral injury incidence increased with the increasing of the slope angle （r=0.611, P=0.000; r=0.852, P=0.000）. The incidence of chondral injury was 69.1% （56/81） and 48.1% （39/81） in groups A and B respectively, showing significant difference （x2=7.356, P=0.007）. The sublevel analysis showed that the chondral injury incidence of group A （36.1%, 13/36） was significantly higher than that of group B （0） at 0-30° （x2=15.864, P=0.000）, but no significant difference was found between group A （95.6%, 43/45） and group B （86.7%, 39/45） at 45-90° （P=0.267）. Conclusion It has more risk of chondral injury to use Rigidfix femoral fixation device via the anteromedial approach than the tibial tunnel approach to reconstruct ACL.

关 键 词：前交叉韧带重建 Rigidfix横穿钉内固定系统 前内侧入路 经胫骨隧道入路 软骨损伤 应用解剖 

分 类 号：R687.3[医药卫生—骨科学]