膝关节镜下不同股骨隧道位置单束韧带重建对治疗前交叉韧带断裂的主观功能的影响  

Subjective Functional Outcomes of Single-Bundle Anterior Cruciate Ligament Reconstruction With Different Femoral Tunnel Positions via Arthroscopy

作　　者：张霄瀚 钱驿 贺忱[3,4] 高颀 高奉[3,4] 周敬滨 ZHANG Xiaohan;QIAN Yi;HE Chen;GAO Qi;GAO Feng;ZHOU Jingbin(School of Sport Medicine and Rehabilitation,Beijing Sport University,Beijing 100084,China;Department of Sport and Rehabilitation Medicine,Beijing Chao-Yang Hospital,Capital Medical University,Beijing 100020,China;Department of Sports Traumatology,Sports Hospital,National Institute of Sports Medicine,General Administration of Sport of China,Beijing 100061,China;Key Laboratory of Sports Trauma and Rehabilitation,General Administration of Sport of China,Beijing 100010,China)

机构地区：[1]北京体育大学运动医学与康复学院,北京100084 [2]首都医科大学附属北京朝阳医院运动与康复医学科,北京100020 [3]国家体育总局运动医学研究所体育医院运动创伤外科,北京100061 [4]国家体育总局运动创伤与康复重点实验室,北京100010

出　　处：《中国医学科学院学报》2024年第6期823-827,共5页Acta Academiae Medicinae Sinicae

基　　金：国家体育总局科技服务(2023-270)

摘　　要：目的比较膝关节镜下使用3种不同股骨隧道位置行单束前交叉韧带(ACL)重建对术后5年主观功能的影响。方法回顾性分析2012年1月至2017年12月国家体育总局运动医学研究所体育医院运动创伤外科收治的165例ACL断裂患者的临床资料,根据股骨隧道位置的不同将患者分为低位中心(LC)组、高位中心(HC)组和高位前内(HAM)组,对3组患者术前和术后5年国际膝关节评分委员会评分、Lysholm评分及术后的ACL-损伤后重返运动量表评分进行比较。结果患者平均随访(60.2±1.52)个月(57~64个月)。术后5年LC、HC、HAM组的国际膝关节文献委员会评分分别为(80.80±10.82)、(77.36±14.36)、(85.33±7.42)分,较术前均显著增加(P均=0.002),术后5年HAM组显著高于LC组和HC组(P=0.022,P=0.008)。术后5年LC、HC和HAM组的Lysholm评分分别为(80.87±10.83)、(77.67±15.23)、(86.10±7.68)分,与术前比较均显著升高(P均=0.002),术后5年HAM组显著高于LC组和HC组(P=0.020,P=0.022)。术后5年LC、HC和HAM组的ACL-损伤后重返运动量表评分分别为(70.39±17.26)、(73.58±16.81)、(83.73±11.10)分,HAM组显著高于LC组和HC组(P=0.014,P=0.038)。结论HAM点作为单束ACL股骨隧道重建位置,术后5年膝关节主观功能更好。因此,推荐HAM点做为ACL重建术的首选股骨隧道的定位点。Objective To compare the five-year subjective functional outcomes of single-bundle anterior cruciate ligament reconstruction(ACLR)with three different femoral tunnel positions under arthroscopic guidance.Methods A retrospective study was conducted on the clinical data of 165 patients who underwent ACLR at the Department of Sports Traumatology,Sports Hospital,National Institute of Sports Medicine,General Administration of Sport of China from January 2012 to December 2017.According to femoral tunnel positions,the patients were assigned into three groups of low centre(LC)section(n=53),high centre(HC)section(n=45),and high anterior medial(HAM)section(n=67).The three groups were compared before and 5 years after surgery regarding the following items:international knee documentation committee(IKDC)score,Lysholm score,and ACL-return to sport after injury(ACL-RSI)scale score.Results All patients were followed up for 57-64 months[(60.2±1.52)months].The IKDC scores in the LC,HC,and HAM groups 5 years after surgery were 80.80±10.82,77.36±14.36,and 85.33±7.42,respectively,and the scores were higher than those before surgery(all P=0.002).The HAM group had higher IKDC score than the LC and HC groups 5 years after surgery(P=0.022,P=0.008).The Lysholm scores in the LC,HC,and HAM groups 5 years after surgery were 80.87±10.83,77.67±15.23,and 86.10±7.68,respectively,which were higher than those before surgery(all P=0.002).Moreover,the HAM group had higher Lysholm score than the LC and HC groups(P=0.020,P=0.022).The ACL-RSI scores in the LC,HC,and HAM groups 5 years after surgery were 70.39±17.26,73.58±16.81,and 83.73±11.10,respectively,and the score was higher in the HAM group than in the LC and HC groups(P=0.014,P=0.038).Conclusions The ACL patients treated by ACLR with the HAM section had better rotational stability and subjective function 5 years after surgery.Therefore,we recommend the HAM section as the preferred femoral tunnel position in ACL reconstruction.

关 键 词：前交叉韧带 股骨隧道定位 主观功能评分 

分 类 号：R686.5[医药卫生—骨科学]