摘要
目的 探讨基于股骨外侧髁软骨顶点(apex of deep cartilage,ADC)结合患者影像学数据设计个性化股骨定位器,辅助前交叉韧带(anterior cruciate ligament,ACL)重建的临床疗效。方法 选取2021年1月—2022年1月符合选择标准的40例初次ACL断裂患者,随机分为研究组(使用基于ADC设计的个性化股骨定位器辅助ACL重建)和对照组(术中透视辅以传统股骨定位器辅助ACL重建),每组20例。两组患者性别、年龄、身体质量指数、患膝侧别、致伤原因及术前国际膝关节文献委员会(IKDC)评分、Lyshlom评分及Tegner评分等基线资料比较差异均无统计学意义(P>0.05)。术前及术后3、6、12个月,采用IKDC评分、Lyshlom评分及Tegner评分评价患膝功能恢复情况。术前及术后行膝关节CT和三维重建检查,测量ADC至前骨缘的水平距离(L)和ADC至骨道中心的水平距离(I),通过I/L计算骨道前后位置R;在二维横断面上测量骨道中心至下骨缘的距离(D);比较两组R值和D值。结果 研究组手术时间明显少于对照组[MD=-6.90(-8.78,-5.03),P<0.001]。两组患者切口均Ⅰ期愈合,未发生关节腔内感染、神经损伤、下肢深静脉血栓形成等并发症。研究组术前模拟定位的R值和D值与术中实际定位的R值和D值比较差异均无统计学意义[MD=0.52(-2.85,3.88),P=0.758;MD=0.36(-0.39,1.11),P=0.351];研究组术中实际定位的R值和D值与对照组比较差异亦无统计学意义[MD=1.01(-2.57,4.58),P=0.573;MD=0.24(-0.34,0.82),P=0.411]。两组患者术后均获随访,随访时间12~13个月,平均12.4个月。随时间延长两组患膝IKDC评分、Lysholm评分及Tegner评分均逐渐增加,手术前后各时间点间差异均有统计学意义(P<0.05);术后各时间点两组间各评分比较差异均无统计学意义(P>0.05)。结论 基于ADC设计的个性化股骨定位器可准确辅助ACL重建术中的股骨隧道定位,相较于传统手术方法缩短了手术时间,早期临床疗效满意。
Objective To investigate the effectiveness of anterior cruciate ligament(ACL)reconstruction assisted by personalized femoral locator based on the apex of deep cartilage(ADC)combined with patient imaging data.MethodlssBetween January 2021 and January 2022,a total of 40 patients with primary ACL rupture were selected and randomly divided into study group(ACL reconstruction assisted by personalized femoral locator based on ADC)and control group(ACL reconstruction assisted by intraoperative fluoroscopy and traditional femoral locator),with 20 cases in each group.There was no significant difference in gender,age,body mass index,affected side,cause of injury,and preoperative International Knee Documentation Committee(IKDC)score,Lyshlom score,and Tegner score between the two groups(P>0.05).IKDC score,Lyshlom score,and Tegner score were used to evaluate the functional recovery of the affected knee before operation and at 3,6,and 12 months after operation.CT scan and three-dimensional reconstruction were performed before and after operation to measure the horizontal distance from ADC to the anterior cartilage margin(L)and the horizontal distance from ADC to the center of the femoral canal(I),and the anteroposterior position of the bone canal(R)was calculated by I/L;the distance from the center to the distal cartilage margin(D)was measured on the two-dimensional cross section;the R value and D value were compared between the two groups.Results The operation time of the study group was significantly less than that of the control group[MD=-6.90(-8.78,-5.03),P<0.001].The incisions of the two groups healed by first intention,and no complication such as intra-articular infection,nerve injury,and deep vein thrombosis of lower limbs occurred.There was no significant difference in the R value and D value between the preoperative simulated positioning and the actual intraoperative positioning in the study group[MD=0.52(-2.85,3.88),P=0.758;MD=0.36(-0.39,1.11),P=0.351].There was no significant difference in the actual intraoperative
作者
何任杰
宁梓文
谷梓铭
施政良
向耀宇
王国梁
李彦林
何川
HE Renjie;NING Ziwen;GU Ziming;SHI Zhengiang;XIANG Yaoyu;WANG Guoiang;LI Yanin;HE Chuan(Department of Sports Medicine,the First Affiliated Hospital of Kunming Medical University,Kunming Yunnan,650032,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2023年第7期833-838,共6页
Chinese Journal of Reparative and Reconstructive Surgery
基金
国家自然科学基金资助项目(81560372)
昆明医科大学第一附属医院“535”高层次人才学科带头人培养项目(2023535D11)
云南省科技厅-昆明医科大学应用基础研究联合专项基金资助项目(202001AY070001-042)
云南省骨关节疾病临床医学中心基金资助项目(ZX2019-03-04)
云南省科技厅重大科技专项计划:云南省骨科与运动康复临床医学研究中心(202102AA310068)
云南省“兴滇英才支持计划”青年人才。
