I.D.E.A.L技术与经胫骨隧道技术重建前交叉韧带的疗效比较研究  

Comparative study of I.D.E.A.L.technique and transtibial technique in anterior cruciate ligament reconstruction

作　　者：王凡 王国梁[1] 李彦林[1] 李骅[1] 施青吕 李黎[1] WANG Fan;WANG Guoliang;LI Yanlin;LI Hua;SHI Qinglü;LI Li(Department of Sports Medicine,the First Affiliated Hospital of Kunming Medical University,Kunming Yunnan,650032,P.R.China)

机构地区：[1]昆明医科大学第一附属医院运动医学科,昆明650032

出　　处：《中国修复重建外科杂志》2024年第8期987-994,共8页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：云南省科技厅技术创新人才培养对象项目(202205AD160007)。

摘　　要：目的比较I.D.E.A.L技术与经胫骨隧道(transtibial,TT)技术重建前交叉韧带(anterior cruciate ligament,ACL)的疗效。方法回顾分析2020年1月—2022年9月收治且符合选择标准的60例ACL损伤患者临床资料。患者均接受关节镜下自体肌腱重建ACL,术中股骨隧道定位采用I.D.E.A.L技术30例(I.D.E.A.L组)、TT技术30例(TT组)。两组患者年龄、性别、身体质量指数、致伤原因、损伤侧别、受伤至手术时间、合并软骨及半月板损伤构成比以及术前Lysholm评分、国际膝关节文献委员会(IKDC)评分、疼痛视觉模拟评分(VAS)、胫骨前移差值、Blumensaat角等基线资料比较,差异均无统计学意义(P>0.05)。记录住院时间、术后早/远期并发症发生情况,采用Lysholm评分、IKDC评分及VAS评分评价膝关节功能及疼痛程度,测量胫骨前移差值;MRI复查观察移植物愈合情况,并测量移植物股骨端、中段、胫骨端信噪比(signal to noise quotien,SNQ)值,以及膝关节Blumensaat角。计算胫骨前移差值以及Blumensaat角的手术前后差值(变化值)进行组间比较。结果术后两组切口均Ⅰ期愈合,住院时间组间差异无统计学意义(P>0.05)。患者均获随访,随访时间12~18个月,平均14.9个月。术后两组膝关节Lysholm评分、IKDC评分均较术前增加,VAS评分降低,其中TT组术后1周VAS评分与术前差异无统计学意义(P>0.05),其余评分两组组内与术前差异均有统计学意义(P<0.05)。术后随时间延长,两组上述评分均呈进一步改善趋势;Lysholm评分、VAS评分术后1周及1、3、6、12个月间差异均有统计学意义(P<0.05),IKDC评分仅术后1个月与术后1周差异有统计学意义(P<0.05)。术后1周I.D.E.A.L组膝关节Lysholm评分、IKDC评分高于TT组、VAS评分更低,差异均有统计学意义(P<0.05);1、3、6、12个月两组间差异均无统计学意义(P>0.05)。术后12个月,两组胫骨前移差值均较术前降低(P<0.05);且I.D.E.A.L组变化值高于TTObjective To compare the effectiveness of I.D.E.A.L technique and transtibial(TT)technique in anterior cruciate ligament(ACL)reconstruction.Methods A clinical data of 60 patients with ACL injury,who were admitted and met the selection criteria between January 2020 and September 2022,was retrospectively analyzed.All patients underwent arthroscopic ACL reconstruction with autologous tendon.During operation,the femoral tunnel was prepared by using I.D.E.A.L technique in 30 cases(I.D.E.A.L group)and using TT technique in 30 cases(TT group).There was no significant difference in baseline data such as age,gender,body mass index,cause of injury,injured side,interval from injury to operation,constituent ratio of combined cartilage and meniscus injury,and preoperative Lysholm score,International Knee Documentation Committee(IKDC)score,visual analogue scale(VAS)score,anterior tibial translation difference,and Blumensaat angle between the two groups(P>0.05).The length of hospital stay and the occurrence of early and late complications were recorded.During follow-up,the Lysholm score,IKDC score,and VAS score were used to evaluate knee joint function and pain degree,and the anterior tibial translation difference was measured.MRI reexamination was performed to observe the healing of the graft,and the signal to noise quotient(SNQ)values of the femoral end,middle section,and tibial end of the graft,as well as the Blumensaat angle of the knee joint were measured.The differences in tibial anterior translation difference and Blumensaat angle before and after operation(change values)were calculated and compared between the two groups.Results The incisions in both groups healed by first intention after operation,and there was no significant difference in the length of hospital stay between the two groups(P>0.05).All patients were followed up 12-18 months,with an average of 14.9 months.The Lysholm score and IKDC score of the knee joint in both groups after operation increased when compared with those before operation,and the VAS score

关 键 词：关节镜 前交叉韧带重建 I.D.E.A.L技术 经胫骨隧道技术 移植物 

分 类 号：R687.4[医药卫生—骨科学]