股骨足印中心定位法单束解剖重建ACL临床效果研究  

Clinical study of the femur footprint center positioning in the ACL single-bundle anatomical reconstruction

作　　者：徐丛[1] 王永为[2] 李嘉[1] 曹向宇[1] 刘文涛[1] 杜元良[1] 戴海峰[1] 刘清晨[1] 吕永明[1] 

机构地区：[1]承德医学院附属医院关节外科 [2]承德医学院解剖教研室,河北承德0670001

出　　处：《中国临床解剖学杂志》2016年第6期685-688,共4页Chinese Journal of Clinical Anatomy

基　　金：河北省承德市科技支撑计划项目(20122184);承德医学院附属医院青年基金(201307)

摘　　要：目的探讨急性前交叉韧带(anterior cruciate ligament,ACL)断裂后镜下单束解剖重建术中股骨骨道实用定位方法及临床效果。方法对ACL断裂患者行关节镜下自体半腱股薄肌腱单束解剖重建术,术中股骨侧骨道采用足印中心定位法,同时术中寻找股骨外侧髁间嵴、分叉嵴等骨性标志对定位点准确性进行校对。术前、术后进行膝关节功能检查及评分,包括前抽屉试验、Lachman试验、pivot shift试验、Lysholm评分、Tegner评分、IKDC评分。结果 (1)镜下100%可见股骨外髁间嵴,但分叉嵴的出现率仅有42%(48/115)。(2)术后前抽屉试验阴性率79%(术后3个月)、77%(术后24月);Lachman试验阴性率80%(术后3个月)、71%(术后24月)、pivot shift试验阴性率97%(术后3个月)、95%(术后24月)。(3)Lysholm评分、Tegner评分及IKDC评分与术前比较差异有统计学意义(P<0.01)。结论 ACL单束解剖重建股骨足印区中心点法能提供足够膝关节稳定性,取得满意临床效果,但对股骨止点残留韧带依赖性高;股骨外侧髁间嵴镜下易于辨认,但分叉嵴辨别率低。Objective To explore the effective femur tunnel positioning method and primary clinical results in arthroscopic single-bundle anterior cruciate ligament （ACL） reconstruction after the acute anterior cruciate ligament （ACL） rupture. Methods All patients with ACL rupture were evaluated after arthroscopic single-bundle ACL reconstruction by means of the autogenous semitendinosus and gracilis tendons and footprint center positioning method in the femur tunnel. The accuracy of the above-mentioned techniques was intra-operatively evaluated through observing the bone marks of lateral femoral epicondyle, and the drawer test, Lachman test, Pivot-shift test, the Lysholm, Tegner and international knee documentation committee （IKDC） scores were used to estimate knee joint function and stability before and after ACL reconstruction. Results （1）the lateral femoral epicondyle was found in all the patients during ACL reconstruction, but the resident ridge was found in only 48 patients. （2）after 3 and 24 months of ACL reconstruction, the negative rate was 79%, 77% for the drawer test, 80%, 71% for the Lachman test and 97%, 95% for the pivot shift test.（3） there were significant differences in Lysholm,Tegner, IKDC scores compared with that prior to ACL reconstruction （P〈0.01）. Conclusion The femur footprint center positioning method in the ACL single-bundle reconstruction provides enough knee joint stability and satisfactory clinical results, but the remnant preservation of ligament in the femur footprint is essential and importantly depended on. While the lateral femoral epicondyle can be easily found, that is not the case for the resident ridge.

关 键 词：ACL 股骨骨道 半腱股薄肌腱 解剖重建 

分 类 号：R322.7[医药卫生—人体解剖和组织胚胎学]