摘要
目的探讨胫骨外侧平台后倾角(lateral posterior tibial slope,LPTS)对单束解剖重建前交叉韧带(anterior cruciate ligament,ACL)术后胫骨隧道扩张影响,以及隧道扩张对膝关节功能的影响。方法回顾分析2018年11月—2019年12月52例因ACL断裂行关节镜下单束解剖重建患者的临床资料。男32例,女20例;年龄14~64岁,平均34.3岁。左膝22例,右膝30例。受伤至手术时间7~30 d,平均15.9 d。术前及术后3、6个月采用国际膝关节文献委员会(IKDC)评分及Lysholm评分评价膝关节功能。术后3、6个月基于MRI测量LPTS及胫骨隧道出口、中段、入口、距关节面出口2 cm处宽度;计算隧道绝对及相对扩张量,并根据绝对扩张量对隧道扩张程度进行分度(0~3度)比较。同时将患者根据LPTS分为<6.0°组(A组)、6°~12°组(B组)、>12°组(C组),比较组间胫骨隧道扩张程度差异。结果 52例患者术后均获随访,随访时间6~12个月,平均7.1个月。术后3、6个月IKDC评分和Lysholm评分与术前比较,术后3、6个月间比较,差异均有统计学意义(P<0.05)。术后胫骨隧道均发生扩张,其中出口和中段相对扩张量术后3、6个月间差异有统计学意义(P<0.05)。术后3个月胫骨隧道扩张程度达0度5例、1度28例、2度16例、3度3例,6个月时分别为5、20、25、2例。不同胫骨隧道扩张程度患者术后同时间点IKDC评分和Lysholm评分比较,差异均无统计学意义(P>0.05)。52例患者LPTS为-0.8°~18.7°,平均10.6°;其中A组7例、B组24例、C组21例。3组患者年龄、性别、术前IKDC评分及Lysholm评分、胫骨隧道初始宽度比较,差异均无统计学意义(P>0.05)。A、B、C组胫骨隧道出口和中段相对扩张量比较,术后3个月时差异均无统计学意义(P>0.05),6个月时差异均有统计学意义(P<0.05)。结论单束解剖重建ACL术后,胫骨隧道在早期均会发生一定程度扩张。LPTS对胫骨隧道扩张有显著影响,该角度越大,胫骨隧道近端扩张
Objective To investigate the influence of lateral posterior tibial slope(LPTS) on tibial tunnel expansion after anatomical single-bundle anterior cruciate ligament(ACL) reconstruction and the effect of tibial tunnel expansion on knee joint function. Methods A clinical data of 52 patients with ACL rupture, who underwent arthroscopic anatomical single-bundle reconstruction between November 2018 and December 2019, was retrospectively analyzed. There were 32 males and 20 females with an average age of 34.3 years(range, 14-64 years). There were 22 cases of left knee and30 cases of right knee. The time from injury to operation ranged from 7 to 30 days, with an average of 15.9 days. The knee function was evaluated by International Knee Documentation Committee(IKDC) score and Lysholm score before operation and at 3 and 6 months after operation. At 3 and 6 months after operation, the LPTS and the width of exit,middle segment, entrance, and 2 cm from the exit of the articular surface of the tibial tunnel were measured based on MRI.The expansion of tibial tunnel was calculated and graded(degrees 0-3). According to LPTS, the patients were divided into group A(<6.0°), group B(6°-12°), and group C(>12°), and the difference in the expansion of tibial tunnel between groups was compared. Results All the 52 patients were followed up 6-12 months(mean, 7.1 months). The IKDC and Lysholm scores at 3 and 6 months after operation were significantly different from those before operation(P<0.05);and the difference of knee scores between 3 and 6 months after operation was significant(P<0.05). The tibial tunnel expanded after operation, and the relative expansion at the exit and the middle segment showed significant difference between3 months and 6 months after operation(P<0.05). The expansion degree of tibial tunnel was rated as degree 0 in5 cases, degree 1 in 28 cases, degree 2 in 16 cases, and degree 3 in 3 cases at 3 months after operation, and degree 0 in 5 cases, degree 1 in 20 cases, degree 2 in 25 cases, and degree 3 in 2 cases
作者
罗浩
向先祥
李瑞欣
李丹妹
王卫明
LUO Hao;XIANG Xianxiang;LI Ruixin;LI Danmei;WANG Weiming(Dalian Medical University,Dalian Liaoning,116027,P.R.China;Department of Sports Medicine,Affiliated Zhongshan Hospital of Dalian University,Dalian Liaoning,116001,P.R.China;Department of Sports Medicine,Affiliated Xinhuan Hospital of Dalian University,Dalian Liaoning,116001,P.R.China;Department of Knee Arthropathy,Luoyang Orthopedic-Traumatological Hospital of Henan Province(Henan Provincial Orthopedic Hospital),Luoyang Henan,471000,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2021年第6期697-703,共7页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
胫骨外侧平台后倾角
骨隧道扩张
膝关节功能
前交叉韧带
韧带重建
Lateral posterior tibial slope
bone tunnel expansion
knee function
anterior cruciate ligament
ligament reconstrcution
