两种股骨隧道止点在单束前交叉韧带解剖重建术中的应用效果比较  

Comparison of application effect of two kinds of femoral tunnel insertions in anatomic reconstruction of the single-bundle anterior cruciate ligament

作　　者：张理选[1] 霍佳邦 郭汉明[1] 王大城[1] 黄杰华[1] ZHANG Li-xuan;HUO Jia-bang;GUO Han-ming;WANG Da-cheng;HUANG Jie-hua(Dept of Sports Medicine,the Central People′s Hospital of Huizhou City,Huizhou,Guangdong 516001,China)

机构地区：[1]惠州市中心人民医院运动医学科,广东惠州516001

出　　处：《临床骨科杂志》2023年第4期523-527,共5页Journal of Clinical Orthopaedics

基　　金：广东省卫健委医学科学技术研究基金(编号:B2019140);广东省惠州市科技局科技计划项目(编号:2019Y013);广东省惠州市中心人民医院博士科研启动项目(惠市心医[2022]2号)。

摘　　要：目的 通过二次关节镜检查移植物的情况比较两种股骨隧道止点在单束前交叉韧带(ACL)解剖重建术中的应用效果。方法 按照股骨隧道止点不同将行单束ACL解剖重建术的患者分为A组[选择前内侧束(AM束)的解剖中点作为股骨隧道止点,38例]和B组[选择AM束与后外侧束(PL束)的交界点作为股骨隧道止点,35例]。术后12个月拆除胫骨门型钉时行二次关节镜检查,记录两组移植物的情况。采用Lysholm评分评价膝关节功能恢复情况。结果 患者均获得随访,时间12~24个月。两组均未发生移植物断裂等并发症。术后12个月,移植物松弛率A组明显低于B组(P<0.05);移植物的张力及滑膜覆盖分型情况A组明显优于B组(P<0.05)。术后12个月Lysholm评分两组均明显高于术前(P<0.05),且A组明显高于B组(P<0.05)。结论 单束ACL解剖重建时,与选择AM束与PL束的交界点作为股骨隧道止点相比,选择AM束的解剖中点更利于移植物的滑膜覆盖和张力的良好保持,可为膝关节提供良好的前向及旋转稳定性,进而延缓关节软骨及半月板的退变。Objective To compare the application effect of two kinds of femoral tunnel insertions in the anatomic reconstruction of single-bundle anterior cruciate ligament(ACL)with secondary arthroscopic examination of graft.Methods The patients who were performed with single-bundle ACL anatomic reconstruction were divided into two groups,according the difference of femoral tunnel insertion;group A(38 cases):anatomic midpoint of anterior medial bundle(AM bundle)was selected as femoral tunnel insertion;group B(35 cases):the junction of AM bundle and posterior lateral bundle(PL bundle)was selected as femoral tunnel insertion.At 12 months after operation,the secondary arthroscopy examination was performed after removing the tibial stapling nail.The grafts status in both groups were recorded.Lysholm score was used to evaluate the functional recovery of knee joint.Results All patients were followed up for 12~24 months.No graft rupture occurred in both groups.At 12 months after operation,the graft relaxation rate in group A was significantly lower than that in group B(P<0.05),and the graft tension and synovial membrane coverage classification in group A were significantly better than those in group B(P<0.05).The Lysholm score:at 12 months postoperation,both groups were significantly higher than the preoperation(P<0.05),and which was significantly higher in group A than group B(P<0.05).Conclusions In anatomic reconstruction of single bundle ACL,compared with selecting the junction of AM bundle and PL bundle as the insertion of femoral tunnel,selecting the anatomic midpoint of AM bundle is more beneficial to the synovium covering of graft and better maintenance of tension,and which can provide good forward and rotational stability of knee joint,thus delaying the degeneration of articular cartilage and meniscus.

关 键 词：前交叉韧带重建 单束重建 解剖重建 二次关节镜检查 

分 类 号：R687.2[医药卫生—骨科学] R687.4[医药卫生—外科学]