前交叉韧带重建术后移植物失效的影响因素分析  

Influencing factors of graft failure after anterior cruciate ligament reconstruction

作　　者：高扬 刘颖[1] 崔鹏[2] 何远铭 董岩[2] Gao Yang;Liu Ying;Cui Peng;He Yuanming;Dong Yan(Department of Anesthesiology,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院麻醉科,100730 [2]首都医科大学附属北京同仁医院骨科,100730

出　　处：《北京医学》2024年第9期733-737,742,共6页Beijing Medical Journal

摘　　要：目的探讨前交叉韧带(anterior cruciate ligament,ACL)重建术后移植物失效的影响因素。方法选取2017年1月至2020年12月首都医科大学附属北京同仁医院行关节镜下ACL单束解剖重建术患者122例,按照ACL术后移植物是否失效分为失效组和未失效组。收集患者基线资料和临床资料,包括胫骨、股骨骨道位置,股骨髁间角,髁间窝宽度指数,内侧胫骨平台后倾角(medial tibial plateau slope,MTPS)和外侧胫骨平台后倾角(lateral tibial plateau slope,LTPS),采用多因素logistic回归方程分析ACL重建术后移植物失效的影响因素。结果122例患者中,男96例、女26例,年龄18~49岁,平均(31.3±4.9)岁。多因素logistic回归分析结果显示,股骨骨道位置越高(OR=2.817,95%CI:1.109~7.154,P=0.029)、MTPS越大(OR=1.239,95%CI:1.071~1.804,P=0.021)、LTPS越大(OR=1.487,95%CI:1.238~1.995,P=0.048)的患者,越容易发生移植物术后失效。结论股骨骨道位置、MTPS和LTPS是ACL重建术后移植物失效的影响因素。建议ACL重建术前测量患者的MTPS和LTPS,并精确定位术中股骨骨道位置,必要时可同时进行手术,矫正过大的MTPS和LTPS。Objective To explore the influencing factors of graft failure after anterior cruciate ligament(ACL)reconstruction.Methods A total of 122 patients who underwent arthroscopic ACL single-bundle anatomical reconstruction in Beijing Tongren Hospital,Capital Medical University from January 2017 to December 2020 were selected,and were divided into failure group and non-failure group according to whether they had graft failure after ACL surgery.Baseline data and clinical data such as tibial and femoral bone canal position,femoral intercondylar angle,intercondylar fossa width index,medial tibial plateau slope(MTPS)and lateral tibial plateau slope(LTPS)of the patients were collected.Multivariate logistic regression equation was used to analyze the influencing factors of graft failure after ACL reconstruction.Results Among the 122 patients,96 were males and 26 were females,aged from 18 to 49 years,with an average age of(31.3±4.9)years.Multivariate logistic regression analysis results showed that patients with higher femoral bone canal position(OR=2.817,95%CI:1.109-7.154,P=0.029),greater MTPS(OR=1.239,95%CI:1.071-1.804,P=0.021)and greater LTPS(OR=1.487,95%CI:1.238-1.995,P=0.048)were more likely to experience postoperative graft failure.Conclusions The position of femoral bone canal,MTPS and LTPS are the influencing factors of graft failure after ACL reconstruction.It is suggested that MTPS and LTPS should be measured before ACL reconstruction,and the position of femoral bone canal should be accurately located during the operation.If necessary,surgery can be performed at the same time to correct excessive MTPS and LTPS.

关 键 词：前交叉韧带 移植物失效 胫骨平台后倾角 骨道位置 股骨髁间角 

分 类 号：R687.4[医药卫生—骨科学]