术中透视定位股骨隧道技术治疗雪上项目职业运动员前交叉韧带损伤  

Intraoperative fluoroscopy on femoral tunnel placement in the treatment of professional snow sports athletes with anterior cruciate ligament injury

作　　者：贺忱[1] 高奉[1] 钱驿 果森 思虹 胥皞 郝悦 杨京伦 周敬滨[1] He Chen;Gao Feng;Qian Yi;Guo Sen;Si Hong;Xu Hao;Hao Yue;Yang Jinglun;Zhou Jingbin(National Institute of Sports Medicine,Sports Trauma and Rehabilitation Laboratory of General Administration of Sport of China,Beijing 100061,China)

机构地区：[1]国家体育总局运动医学研究所、国家体育总局运动创伤和康复实验室,北京100061

出　　处：《中华创伤杂志》2023年第6期500-507,共8页Chinese Journal of Trauma

摘　　要：目的探讨术中透视定位股骨隧道技术治疗雪上项目职业运动员前交叉韧带(ACL)损伤的疗效。方法采用回顾性病例系列研究分析2016年1月至2019年1月年国家体育总局运动医学研究所收治的13例ACL损伤雪上项目职业运动员的临床资料,其中男5例,女8例;年龄16~27岁[(18.5±3.0)岁]。均采用自体腘绳肌腱单束重建ACL,术中行膝关节纯侧位透视,联合四格法精确定位股骨隧道。比较术前(或伤前)和术后3,6,12,24个月膝关节KT1000患健侧差值(KT1000‑ssd)、轴移试验、国际膝关节文献委员会(IKDC)主观评分、Lysholm评分、Marx活动量表评分及患健侧伸屈膝最大抗阻力比值。每次随访时记录运动员是否重返赛场、重返赛场时间及再损伤情况。评估术后24个月患膝MRI中ACL移植物的信号强度比(SIR)。结果13例运动员均获随访24~33个月[(25.8±2.7)个月]。术前膝关节KT1000‑ssdⅠ度7例,Ⅱ度5例,Ⅲ度1例;术后3,6个月膝关节KT1000‑ssd 0度12例,Ⅰ度1例;术后12,24个月膝关节KT1000‑ssd 0度13例。术前患膝轴移试验Ⅰ度8例,Ⅱ度5例;术后3个月患膝轴移试验0度11例,Ⅰ度2例;术后6,12,24个月患膝轴移试验0度12例,Ⅰ度1例。术后3,6,12,24个月IKDC主观评分分别为(68.0±4.3)分、(84.7±7.9)分、(94.6±3.3)分、(96.5±1.8)分;术后6个月开始,IKDC主观评分较术前的(48.3±25.0)分显著提高(P均<0.01)。术后3,6,12,24个月Lysholm评分分别为(63.4±6.6)分、(80.1±6.5)分、(93.8±4.6)分、(96.5±2.4)分;术后6个月开始,Lysholm评分较术前的(47.5±29.4)分显著提高(P均<0.01)。术后3,6,12,24个月Marx活动量表评分分别为(7.4±0.5)分、(13.8±0.7)分、(14.6±0.8)分、(15.0±0.7)分,均较伤前的(16.0±0.0)分显著降低(P均<0.01)。术后3,6,12,24个月患健侧伸膝最大抗阻力比值分别为0.60±0.10、0.85±0.08、0.91±0.06、0.97±0.04。术后6个月开始,患健侧伸膝最大抗阻力比值较术前的0.57±0.18显著提高(P均<Objective To explore the clinical outcomes of intraoperative fluoroscopy on femoral tunnel placement in treating professional snow sports athletes with anterior cruciate ligament(ACL)injury.Methods A retrospective case series study was used to analyze the clinical data of 13 professional snow sports athletes with ACL injury treated in the National Institute of Sports Medicine,General Administration of Sport of China from January 2016 to January 2019.There were 5 males and 8 females,aged 16‑27 years[(18.5±3.0)years].Intraoperative lateral fluoroscopy combined with quadrant method was performed for the accurate femoral tunnel placement in single‑bundle ACL reconstruction by using autologous hamstring tendon in all patients.KT1000 side‑to‑side difference(KT1000‑ssd),pivot shift test,International Knee Documentation Committee(IKDC)subjective score,Lysholm score,Marx activity scale and maximum extension and flexion resistance ratio of the involved and uninvolved knee were compared before operation(or before injury)and at 3,6,12 and 24 months after operation.Whether returning to the field,time taken in returning to the field and re‑injury were recorded at each follow‑up visit.ACL graft signal intensity ratio(SIR)in MRI of the involved knee was evaluated at postoperative 24 months.Results All patients were followed up for 24‑33 months[(25.8±2.7)months].There were 7 patients with KT1000‑ssd degree I,5 with degree II and 1 with degree III before operation,compared to 12 patients with KT1000‑ssd degree 0 and 1 with degree I at 3 and 6 months after operation and 13 patients with KT1000‑ssd degree 0 at 12 and 24 months after operation.The pivot shift test was grade I in 8 patients and grade II in 5 before operation,compared to 11 patients with degree 0 and 2 with degree I at 3 months after operation and 12 patients with degree 0 and 1 with degree I at 6,12 and 24 months after operation.IKDC subjective score was(68.0±4.3)points,(84.7±7.9)points,(94.6±3.3)points and(96.5±1.8)points at postoperative

关 键 词：前交叉韧带损伤 雪上运动 运动员 重返运动 

分 类 号：R873[医药卫生—运动医学]