非接触性前十字韧带损伤初次重建术后失效的危险因素  

Risk factors for primary anterior cruciate ligament reconstruction failure

作　　者：倪乾坤 张辉[1] 宋关阳[1] 张志军 郑峒 冯峥 曹晏维 冯华[1] Ni Qiankun;Zhang Hui;Song Guanyang;Zhang Zhijun;Zheng Tong;Feng Zheng;Cao Yanwei;Feng Hua(Sports Medicine Service,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院运动损伤科,100035

出　　处：《中华骨科杂志》2020年第7期389-396,共8页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金(81572153);北京市医院管理局"登峰"计划专项经费资助课题(DFL20180402)。

摘　　要：目的探讨非接触性前十字韧带(anterior cruciate ligament,ACL)损伤初次重建术后失效的危险因素。方法2015年11月至2017年5月连续收治并随访2年以上的非接触性ACL损伤而行ACL初次重建的患者178例。随访2年内25例患者出现MRI证实的ACL移植物完全断裂或轴移试验阳性或KT-1000侧侧差值超过5 mm或MRI上静态胫骨前移超过5 mm判定为术后失效,纳入术后失效组;按照1∶2的比例匹配术后2年内未失效者50例,纳入术后未失效组。比较两组患者性别、年龄、体质指数(body mass index,BMI)、患侧分布、半月板损伤侧分布、受伤至手术时间、术前麻醉下KT-1000侧侧差值、轴移试验、随访时间、术前下肢负重位全长X线片上胫骨平台后倾角及胫骨前移的差异,采用多因素Logistic回归分析确定ACL损伤初次重建术后失效的危险因素。结果术后失效组的胫骨平台后倾角为17.21°±2.20°,大于术后未失效组的14.36°±2.72°,差异有统计学意义(t=4.395,P<0.001);术后失效组的术前胫骨前移为(8.29±3.42)mm,大于术后未失效组的(4.09±3.06)mm,差异有统计学意义(t=5.504,P<0.001)。两组性别、年龄、BMI、患侧分布、半月板损伤侧分布、受伤至手术时间、麻醉下KT-1000侧侧差值、轴移试验分度、随访时间的差异均无统计学意义(P>0.05)。多因素回归分析结果显示胫骨平台后倾角≥17°是ACL术后失效的独立危险因素(OR=15.62,P=0.002),胫骨前移≥6 mm是ACL术后失效的独立危险因素(OR=9.91,P=0.006);而性别、年龄、BMI、半月板是否损伤、轴移试验分度、KT-1000侧侧差值与术后失效无相关性(P>0.05)。结论术前下肢负重位全长X线片上胫骨平台后倾角≥17°和胫骨前移≥6 mm可增加ACL损伤初次重建术后失效的风险。Objective To explore the risk factors of primary anterior cruciate ligament(ACL)reconstruction failure.Methods From November 2015 to May 2017,a total of 178 consecutive patients with clinically diagnosed non-contact ACL injury were treated and followed-up more than 2 years.Twenty-five patients(post-operative failure group)who underwent completely ruptured ACL graft confirmed by MRI,positive pivot-shift test,more than 5 mm side-to-side difference(SSD)measured by KT-1000 arthrometer,more than 5 mm static anterior tibial translation(ATT)measured on MRI were determined to be ACL reconstruction failure.They were matched in a 1∶2 fashion to 50 non-failure patients(post-operative non-failure group),who showed intact ACL graft 2 years after ACL reconstruction.The sex,age,body mass index(BMI),affected side,meniscal injury side,time from injury to surgery,KT-1000 SSD,pivot shift test under anesthesia,follow-up duration,posterior tibial slope(PTS)and ATT measured on the pre-operative weight-bearing whole leg radiographs between the two groups were compared using univariate analysis.Moreover,the predictors of ACL reconstruction failure were assessed by multivariable conditional Logistic regression analysis.Results Post-operative failure group had a significantly higher PTS and ATT values than those in the post-operative non-failure group(17.21°±2.20°vs 14.36°±2.72°,t=4.395,P<0.001;8.29±3.42 mm vs 4.09±3.06 mm,t=5.504,P<0.001).The sex,age,BMI,affected side,meniscal injury side,time from injury to surgery,KT-1000 SSD,pivot shift test under anesthesia,follow-up duration between the two groups showed no significant difference(P>0.05).Multivariable Logistic regressions indicated that PTS≥17°(OR=15.62,P=0.002)and ATT≥6 mm(OR=9.91,P=0.006)were independent risk factors for primary ACL reconstruction failure.However,sex,age,BMI,meniscal lesions,degree of pivot shift test,KT-1000 SSD were not the independent risk factors.Conclusion PTS≥17°and ATT≥6 mm could increase the risk of primary ACL reconstruction failure.

关 键 词：前交叉韧带重建 治疗失败 危险因素 

分 类 号：R687[医药卫生—骨科学]