前交叉韧带重建术中胫骨端三种固定方式的近期疗效比较  

Comparison of short-term curative effects between three fixations of the tibial end in reconstruction of the anterior cruciate ligament

作　　者：唐曌 江辉 孟嘉 杨晓江 袁涛 李岩 包倪荣 Tang Zhao;Jiang Hui;Meng Jia;Yang Xiaojiang;Yuan Tao;Li Yan;Bao Nirong(Department of Orthopaedics,Jinling Clinical Medical College(General Hospital of Eastern Theater Command),Nanjing Medical University,Nanjing 210002,China)

机构地区：[1]南京医科大学金陵临床医学院(东部战区总医院)骨科,南京210002

出　　处：《中华创伤骨科杂志》2023年第10期897-901,共5页Chinese Journal of Orthopaedic Trauma

基　　金：中国博士后科学基金第72批面上项目(2022M723893);东部战区总医院院内课题(22LCZLXJS31)。

摘　　要：目的比较前交叉韧带(ACL)重建术中胫骨端使用界面螺钉、界面螺钉+门型钉、界面螺钉+无结铆钉固定的近期疗效。方法回顾性分析2019年1月至2021年12月期间南京医科大学金陵临床医学院骨科因ACL损伤而行重建手术治疗的150例患者资料。根据术中胫骨端的固定方式不同分为3组:A组51例,男40例,女11例;年龄(29.8±10.6)岁;胫骨端采用界面螺钉固定。B组55例,男47例,女8例;年龄(28.6±6.9)岁;胫骨端采用界面螺钉+门型钉固定。C组44例,男39例,女5例;年龄(28.6±8.1)岁;胫骨端采用界面螺钉+无结铆钉固定。比较3组患者术后12、48周的国际膝关节文献委员会(IKDC)评分和Lysholm膝关节评分、术后4周局部疼痛发生率及术后48周膝关节稳定性(前抽屉试验)等。结果3组患者术前一般资料及随访时间比较差异均无统计学意义(P<0.05),具有可比性。B组和C组患者术后12周IKDC评分[(74.27±3.32)、(76.48±3.83)分]和Lysholm膝关节评分[(77.65±3.14)、(79.75±5.39)分]均显著高于A组患者[(69.73±6.04)、(71.63±3.36)分],差异均有统计学意义(P<0.05);而术后48周3组患者之间评分比较差异均无统计学意义(P>0.05)。术后4周B组患者胫骨端局部疼痛发生率(9.1%,5/55)显著高于A组(0,0/51)、C组患者(2.3%,1/44),术后48周A组患者前抽屉试验结果(阴性36例,Ⅰ度14例,Ⅱ度1例)显著劣于B组(阴性50例,Ⅰ度5例)、C组患者(阴性40例,Ⅰ度4例),差异均有统计学意义(P<0.05)。结论ACL重建术中胫骨端使用3种固定方式均可以获得良好的近期疗效,界面螺钉+无结铆钉固定的韧带松弛率较界面螺钉固定低,早期膝关节功能评分更好,且较界面螺钉+门型钉固定更不易发生局部疼痛。Objective To compare the short-term curative effects between 3 fixations of the tibial end with an interface screw,an interface screw+a portal nail and an interface screw+a knotless rivet in reconstruction of the anterior cruciate ligament(ACL).Methods A retrospective study was conducted to analyze the data of 150 patients who had undergone reconstruction surgery for ACL injury at Department of Orthopaedics,Jinling Clinical Medical College,Nanjing Medical University from January 2019 to December 2021.The patients were divided into 3 groups according to their different fixations of the tibial end.In group A of 51 cases subjected to fixation of the tibial end with an interface screw,there were 40 males and 11 females with a mean age of(29.8±10.6)years.In group B of 55 cases whose tibial end was fixated with an interface screw+a portal nail,there were 47 males and 8 females with a mean age of(28.6±6.9)years.In group C of 44 cases whose tibial end was fixated with an interface screw+a knotless rivet,there were 39 males and 5 females with a mean age of(28.6±8.1)years.The 3 groups were compared in terms of International Knee Documentation Committee(IKDC)scoring and Lysholm knee function scoring at 12 and 48 weeks after operation,incidence of local pain at 4 weeks after operation,and stability of the knee at 48 weeks after operation.Results There was no significant difference in the preoperative general data or follow-up time between the 3 groups,indicating comparability(P>0.05).At 12 weeks after surgery,in Group B and Group C,the IKDC scores[(74.27±3.32)and(76.48±3.83)points]and Lysholm knee joint scores[(77.65±3.14)and(79.75±5.39)points]were significantly better than those in Group A[(69.73±6.04)and(71.63±3.36)points](P<0.05).However,there was no statistically significant difference in the above scores among the 3 groups at 48 weeks after surgery(P>0.05).The incidence of local pain at the tibial end in group B(9.1%,5/55)was significantly higher than that in group A(0,0/51)and group C(2.3%,1/44)at 4 weeks afte

关 键 词：前交叉韧带 关节镜检查 胫骨 界面螺钉 铆钉 门型钉 

分 类 号：R687.4[医药卫生—骨科学]