不同固定方式在膝关节前交叉韧带重建术后对胫骨骨隧道的影响  

Effects of Different Fixation Methods on Tibial Bone Tunnel after Anterior Cruciate Ligament Reconstruction

作　　者：程松苗 胡勇[1] 陈鹏旭 蒋旭 范志航 陈君蓉[1] Cheng Songmiao;Hu Yong;Chen Pengxu(Department of Knee Joint Sports Injury,Sichuan Orthopedic Hospital,Chengdu,Sichuan 610041,China)

机构地区：[1]四川省骨科医院膝关节运动损伤科,四川成都610041

出　　处：《四川医学》2020年第5期454-458,共5页Sichuan Medical Journal

基　　金：四川省卫健委科研基金项目(编号:16PJ388)。

摘　　要：目的评价膝关节前交叉韧带断裂重建术中应用不同方式(横穿钉技术和界面螺钉)固定移植物对术后胫骨骨隧道的影响及临床疗效差异。方法应用前瞻性随机对照的方法,将2016年7月至2017年12月我科收治的204例膝关节前交叉韧带断裂患者,随机分为试验组和对照组各102例,试验组患者移植物胫骨端固定采用横穿钉固定技术(Rigidfix),对照组患者采用界面螺钉技术(intrafix)固定胫骨端移植物。术后第1天、第3月、6月、12月拍摄X线片测量胫骨隧道大小,Lyshlom评价膝关节功能,轴移试验和KT-1000评价关节松弛度。结果204例患者获得12月以上的随访。与术后第1天比较,术后3月,试验组的胫骨隧道直径扩大均值较对照组小,差异无统计学意义(P>0.05);术后6月、12个月后对比,试验组的胫骨隧道直径扩大均值要小于对照组,且差异有统计学意义(P<0.05);KT-1000检查两组差异无统计学意义(P<0.05);按照膝关节Lysholm评分标准,均较术前显著改善,两组差异无统计学意义(P>0.05)。结论关节镜下前交叉韧带重建胫骨端使用rigidfix固定和Intrafix在患者术后关节稳定性,关节功能恢复上疗效相近,由于其更靠近隧道内口固定,可以明显减少肌腱在胫骨隧道摆动,降低胫骨隧道的扩大。Objective To evaluate the effect of different methods(transverse nail technique and interface screw)fixation of the graft on the tibial tunnel after the reconstruction of the anterior cruciate ligament rupture of the knee joint and the difference in clinical efficacy.Methods A prospective randomized control method was used.From July 2016 to December 2017,204 patients with knee anterior cruciate ligament rupture treated in our department were selected.Transverse nail technique(rigidfix)were used to fix the tibial end graft in experimental group(EG,n=102).Interface screw(intrafix)were used to fix the tibial end graft in control group(CG,n=102).On the postoperative 1st day,3rd,6th,and 12th months,X-ray films were taken to measure the size of the tibial tunnel.Lyshlom was used to evaluate the function of the knee joint,the axial shift test and KT-1000 were used to evaluate the degree of joint relaxation.Results 204 patients were followed up for more than 12 months.Compared with the 1st day after operation,the mean tibial tunnel diameter enlargement in EG was smaller than that in CG at 3 months after operation,and the difference was not statistically significant(P>0.05).Compared with 6 and 12 months after operation,the mean diameter expansion of the tibial tunnel in EG was smaller than that in CG,and the difference was statistically significant(P<0.05).KT-1000 showed no significant difference between two groups(P<0.05).According to the Lysholm scoring standard of the knee joints,it was significantly improved compared with that before operation,and there was no significant difference between two groups.Conclusion Arthroscopic anterior cruciate ligament reconstruction of the tibial end using rigidfix and intrafix is similar in postoperative joint stability and joint function recovery.Because it is fixed closer to the inner mouth of the tunnel,it could significantly reduce the swing of the tendon in the tibial tunnel and reduce the expansion of the tibial tunnel.

关 键 词：前交叉韧带重建 胫骨骨隧道 胫骨端固定 横穿钉技术 界面螺钉 

分 类 号：R686.5[医药卫生—骨科学]