全内与传统隧道技术重建前十字韧带术后隧道扩大程度及疗效的比较  

Comparative analysis of tunnel enlargement after reconstruction of the anterior cruciate ligament of the knee by all-inside versus conventional tunneling methods

作　　者：严承远 方超 高竞宇 赵其纯 Yan Chengyuan;Fang Chao;Gao Jingyu;Zhao Qichun(Wannan Medical College,Wuhu 241002,China;Department of Sports Medicine,the First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital),Hefei 230001,China)

机构地区：[1]皖南医学院,芜湖241002 [2]中国科学技术大学附属第一医院(安徽省立医院)运动医学科,合肥230001

出　　处：《中华骨科杂志》2024年第7期447-455,共9页Chinese Journal of Orthopaedics

基　　金：科大新医学项目(WK9110000143);安徽省卫生健康科研项目(AHWJ2022b060)。

摘　　要：目的比较采用全内技术与传统由外向内移植物引人技术重建前十字韧带(anteriorcruciateligament,ACL)术后隧道扩大程度及临床疗效。方法回顾性分析2021年12月至2022年7月中国科学技术大学附属第一医院收治前十字韧带损伤患者47例,根据重建ACL方式分为全内技术组和传统技术组。全内技术组25例,男18例、女7例,年龄(27.72±7.33)岁,左17例、右8例;传统技术组22例,男11例、女11例,年龄(27.82±7.12)岁,左11例、右11例。比较两组住院天数、手术时间、疼痛视觉模拟评分(visual analogue scale,VAS)、Lysholm评分、国际膝关节文献委员会(International KneeDocumentationCommittee,IKDC)评分及Tegner评分。通过术后1年CT扫描评估股骨与胫骨隧道扩大程度。结果所有患者均获得随访,随访时间(15.64±2.04)个月(范围12~21个月)。全内技术组手术时间为(178.60±42.90)min,长于传统技术组的(133.60±28.77)min(t=4.163,P<0.001)。全内技术组术后第1天、第15天VAS评分[(7.08±1.29)分、(5.56±1.33)分]均较传统技术组[(7.96±1.29)分、(6.32±1.13)分]低(P<0.05)。术后第1、6、12个月VAS评分两组差异无统计学意义(P>0.05)。全内技术组和传统技术组术前Lysholm、IKDC及Tegner评分分别为(34.00±18.63)分、(36.24±15.01)分、(1.20±1.12)分和(36.18±13.64)分、(38.23±14.94)分、(1.55±1.14)分,术后6个月分别为(72.60±13.95)分、(74.12±12.03)分、(3.56±1.05)分和(68.41±10.80)分、(66.59±17.93)分、(3.23±1.15)分,术后12个月分别为(92.32±5.23)分、(81.40±7.24)分、(5.28±1.62)分和(91.27±6.32)分、(82.18±7.26)分、(4.96±1.25)分。术后6个月两组功能均较术前改善(P<0.05),术后12个月进一步改善(P<0.05);两组间功能评分的差异均无统计学意义(P>0.05)。术后1年,全内技术组股骨及胫骨隧道扩大值为(1.78±1.03)mm和(1.18±0.97)mm,均小于传统技术组的(2.30±1.33)mm和(1.83±1.00)mm,差异有统计学意义(P<0.05)。传统技术组股�Objective To compare the postoperative tunnel enlargement and clinical outcomes of anterior cruciate liga-ment(ACL)reconstruction using the all-inside technique with the traditional outside-in graft introduction technique.MethodsA retrospective analysis was conducted on 47 patients with ACL injuries who were admitted to the First Hospital of the University of Science and Technology of China between December 2021 and July 2022.The patients were categorized into two groups based on the surgical approach used for ACL reconstruction.There were 25 cases in the all-inside group,18 males and 7 females,aged 27.72±7.33 years,17 cases on the left side and 8 cases on the right side;22 cases in the traditional group,11 males and 11 fe-males,aged 27.82±7.12 years,11 cases on the left side and 11 cases on the right side.Clinical parameters including the length of hospital stay,surgical duration,pain levels assessed via the visual analogue scale(VAS),Lysholm score,International Knee Docu-mentation Committee(IKDC)score,and Tegner score were recorded and compared between the two groups.Additionally,femoral and tibial tunnel enlargement was evaluated using postoperative CT scans conducted one year after surgery.ResultssAll patients were followed up for 15.64±2.04 months(range,12-21 months).The mean operation time was 178.60+42.90 min in the all-inside group and 133.60±28.77 min in the traditional group,indicating a statistically significant longer operation time in the all-inside group(P<0.05).On postoperative days 1 and 15,the VAS scores were lower in the all-inside group(7.08±1.29 and 5.56±1.33 points)compared to the conventional group(7.96±1.29 and 6.32±1.13 points),with a statistically significant difference(P<0.05).However,the differences in VAS scores between the two groups at postoperative months 1,6,and 12 were not statistically significant(P>0.05).The preoperative Lysholm,IKDC,and Tegner scores in the all-inside group and the conventional group were 34.00±18.63,36.24±15.01,1.20±1.12 points and 36.18±13.64,38.2

关 键 词：前交叉韧带损伤 前交叉韧带重建 关节镜检查 全内技术 

分 类 号：R687.3[医药卫生—骨科学]