应用Transtibial技术进行前交叉韧带生物力学止点重建的病例系列研究  

A Case Series Study of Anterior Cruciate Ligament Reconstruction within Biomechanical Insertion Using Transtibial Technique

作　　者：张家豪[1] 牛星跃 邵嘉艺 胡晓青[1] 敖英芳[1] Zhang Jiahao;Niu Xingyue;Shao Jiayi;Hu Xiaoqing;Ao Yingfang(Institute of Sports Medicine,Peking University Third Hospital,Beijing Key Laboratory of Sports Injuries,Beijing 100191,China)

机构地区：[1]北京大学第三医院运动医学研究所,北京市运动医学关节伤病重点实验室,北京100191

出　　处：《中国运动医学杂志》2020年第8期594-599,共6页Chinese Journal of Sports Medicine

基　　金：北京大学第三医院院临床重点项目(BYSY2018005)。

摘　　要：目的:评估应用Transtibial技术进行前交叉韧带(anterior cruciate ligament,ACL)生物力学止点重建的骨道孔径、定位及临床效果。方法:回顾性分析2015年6月至2017年6月间于北京大学运动医学研究所应用Transtibial技术进行生物力学止点重建的患者30例,利用CT对骨道长短径进行测量,评估其是否与理论值匹配,并对骨道中心点进行定位分析,评估是否满足解剖定位,对术前及术后2年左右随访的Tegner评分、Lysholm评分、IKDC主观功能评分,KT-2000结果进行统计分析,评估临床效果。结果:术后CT显示胫骨端和股骨端长径测量值和理论值基本匹配,而短径测量值和理论值相比偏大。胫骨骨道中心点位于胫骨长度的前38.8%和宽度的内43.4%,定位偏内侧;股骨骨道中心点位于Blumensaat’s线水平的股骨外侧髁长度的后24.8%和高度的上33.2%,满足解剖定位。术后临床功能评分及膝关节前后向稳定性均较术前显著改善。结论:应用Transtibial技术进行ACL生物力学止点重建可以使骨道长短径与理论值良好匹配,满足解剖定位,并获得良好临床效果。Objective To explore the tunnel aperture,location and clinical outcome after anterior cruciate ligament(ACL)biomechanical insertion reconstruction(BIR)using the transtibial(TT)technique.Methods A retrospective analysis was performed on 30 patients undergoing ACL-BIR using the TT technique in the Institute of Sports Medicine of Peking University between June 2015 and June 2017.The major and minor axis of the tunnel apertures were measured using CT to evaluate against the theoretical values,and the tunnel location was analyzed to evaluate whether it met the criteria for the anatomical insertion.Before and two years after the surgery,all patients were evaluated using the Tegner score,Lysholm score,International Knee Documentation Committee(IKDC)subjective function score,and KT-2000 results were analyzed to evaluate the clinical effect.Results Postoperative CT showed that the measured values of the axis matched the theoretical values,while the measured values of the minoraxis were larger than the theoretical values.The center of the tibial tunnel was located at 38.8%in the anterior–posterior direction and 43.4%in the medial–lateral direction,and that of the femoral tunnel was at 24.8%in the high–low direction and 33.2%in the deep–shallow direction,satisfying the demanded anatomical location.Postoperative clinical functional scores and A-P knee stability improved significantly compared with before surgery.Conclusion With properly created tunnels inside the anatomical attachment areas,ACL-BIR using TT technique matches the theoretical values,and can provide satisfactory clinical results.

关 键 词：前交叉韧带 生物力学止点重建 CT 骨道定位 临床效果 

分 类 号：R687.4[医药卫生—骨科学]