自体单束前交叉韧带移植重建不同股骨隧道位置对髌股关节的影响  

Effect of different femoral tunnel locations on patellofemoral joint during single-bundle anterior cruciate ligament reconstruction

作　　者：林圆 徐斌[1] 涂俊[1] 徐洪港[1] 郭瑞鹏[1] Lin Yuan;Xu Bin;Tu Jun;Xu Honggang;Guo Ruipeng(Department of Sports Trauma and Arthroscopic Surgery,First AfFiliated Hospital of Anhui Medical University,Hefei 230022,Anhui Province,China)

机构地区：[1]安徽医科大学第一附属医院院运动创伤与关节镜外科

出　　处：《中国组织工程研究》2020年第14期2140-2146,共7页Chinese Journal of Tissue Engineering Research

摘　　要：背景:研究显示,关节镜下膝关节单束前交叉韧带重建可以恢复膝关节的前向稳定性,但膝关节旋转稳定性及髌股关节匹配程度却受股骨及胫骨隧道中心位置的影响。目的:分析青壮年前交叉韧带重建不同股骨隧道中心点位置与髌股关节软骨情况及髌骨倾斜的关系,同时对患者研究因素进行相关性分析,从而进一步探讨对髌股关节软骨及髌骨位置影响最小的股骨隧道位置的选择。方法:将70例经过术前磁共振检查、查体及术中关节镜探查明确诊断为前交叉韧带断裂的患者,根据随机数字的奇偶将所有患者分为类等长组(使用股骨定位器定位于髁间窝外侧壁过顶点远端7 mm打入克氏针)和类解剖组(于髁间窝外侧壁、原前交叉韧带足印中心方向打入克氏针)。采用标准化网格系统上的近-远-前-后平面对股骨隧道中心坐标进行评估;前-后-内-外平面对胫骨隧道中心坐标进行评估,标记为象限Y%和象限X%。比较两组患者基线数据、髌股外侧角的差值、软骨定量T2值有无差异以及各研究因素之间相关性。研究方案的实施符合安徽医科大学第一附属医院的相关伦理要求,参与试验的患者均签署了"知情同意书"。结果与结论:①类解剖与类等长两组之间基线数据之间无显著性差异;髌股外侧角差值类解剖组(0.57±0.33)°<类等长组(1.55±0.36)°(P<0.001);②类解剖组髌骨内侧、髌骨外侧、滑车软骨T2值均小于类等长对应值;③象限X%与髌股外侧角差值具有显著负相关性(R=-0.664,P<0.01);象限Y%与髌股外侧角差值呈正相关(R=0.804,P<0.01);髌股外侧角差值与滑车及髌骨外软骨T2值明显正相关(R=0.651,0.655,P<0.01);滑车及髌骨外侧软骨T2值与术后Lysholm评分呈负相关(R=-0.505,-0.529,P<0.01);象限Y%与髌骨外侧T2值高度相关(R=0.825,P<0.01),与滑车软骨T2值显著相关(R=0.798,P<0.01);象限X%与髌骨外侧及滑车软骨T2值呈显著负BACKGROUND:Studies have shown that arthroscopic single-bundle anterior cruciate ligament reconstruction can restore the forward stability of the knee joint,but the rotational stability of the knee joint and the matching degree with the patellofemoral joint are affected by the central position of the femoral and tibial tunnels.OBJECTIVE:To investigate the relationship between the location of different femoral tunnel centers and patellofemoral articulation and cartilage conditions in young and middle-aged patients with anterior cruciate ligament reconstruction,and to carry out the correlation analysis of patient study factors to further explore the location of the femoral tunnel with the least influence on the patellofemoral joint.METHODS:Seventy patients with anterior cruciate ligament rupture were diagnosed by preoperative MRI,physical examination and intraoperative arthroscopy.All patients were divided into quasi-isometric group and quasi-anatomical group according to the parity of random numbers.In the quasi-isometric group,a Kirschner needle was inserted 7 mm distal to the apex of the lateral wall of the intervertebral fossa using a femoral locator.In the quasi-anatomical group,the Kirschner needle was inserted at the lateral wall of the intercondylar fossa and at the foot print center of the original anterior cruciate ligament.The central coordinates of the femoral tunnel were evaluated on the near-far-front-rear plane based on a standardized grid system,while the central coordinates of the tibial tunnel was evaluated on the anterior-posterior-inner-outer plane,labeled as quadrant Y%and quadrant X%.By comparing the baseline data of patients in the two groups,the difference of lateral patellofemoral angle(LPFA),the difference of cartilage quantitative T2 value,and the correlation between various research factors,the surgical operators were further guided to carry out clinical practice.The implementation of the study protocol complied with the relevant ethical requirements of the First Affiliated Hospital of An

关 键 词：前交叉韧带重建术 髌股关节病 髌骨倾斜角 T2弛豫图 相关性分析 

分 类 号：R446[医药卫生—诊断学] R496[医药卫生—临床医学]