摘要
目的 比较关节镜下经胫骨隧道与经前内入路重建前交叉韧带术后膝关节稳定性。方法 选择2019年9月至2022年12月南阳市第一人民医院收治的96例前交叉韧带损伤患者为研究对象,按照手术方式不同将患者分为经胫骨隧道组和经前内入路组,每组48例。经胫骨隧道组患者接受关节镜下经胫骨隧道前交叉韧带重建治疗,经前内入路组患者接受关节镜下经前内入路前交叉韧带重建治疗。手术过程中于关节镜下使用测深尺测量2组患者的股骨骨道长度,测量2组患者手术后1周时的股骨骨道冠状面中心线与关节线夹角角度及股骨纵轴线与股骨骨道夹角;采用Lachman试验和轴移试验评估2组患者术后1 a的膝关节稳定性,采用Lysholm评分和国际膝关节文献委员会膝关节评估表(IKDC)评估2组患者术前、术后1 a膝关节功能;比较2组患者术后并发症发生情况。结果 经胫骨隧道组患者的股骨骨道长度显著长于经前内入路组(P<0.001),股骨骨道冠状面中心线与关节线夹角角度、股骨纵轴线与股骨骨道夹角显著大于经前内入路组(P<0.001)。术后1 a,经胫骨隧道组患者的Lachman试验阴性率和轴移试验阴性率显著低于经前内入路组(P<0.05)。术前、术后1 a,经胫骨隧道组与经前内入路组患者的Lysholm、IKDC评分比较差异无统计学意义(P>0.05);2组患者术后1 a的Lysholm、IKDC评分显著高于术前(P<0.001)。经胫骨隧道组和经前内入路组患者手术后并发症发生率分别为10.42%(5/48)、6.25%(3/48);2组患者手术后并发症发生率比较差异无统计学意义(χ^(2)=0.136,P>0.05)。结论 经胫骨隧道、经前内入路均可作为关节镜下前交叉韧带重建术的入路方式,其中经前内入路能够获得更好的镜下视野、准确的定位及足够的隧道长度,利于维持膝关节稳定性,且具有良好安全性。
Objective To compare the stability of the knee joint after arthroscopic reconstruction of anterior cruciate ligament through tibial tunnel and trans-anterior internal approach.Methods A total of 96 patients admitted to Nanyang First People′s Hospital from September 2019 to December 2022 were selected as the study subjects,and they were divided into the trans-tibial tunnel group and the trans-anterior internal approach group according to the different surgical methods,with 48 cases in each group.The length of the femoral canal was measured using a depth gauge under arthroscopy during the surgery in the two groups.The angle between the coronal centerline of the femoral canal and the joint line,as well as the angle between the longitudinal axis of the femur and the femoral canal of patients were measured one week after the surgery in the two groups;the knee joint stability of patients were evaluated by using the Lachman test and axial shift test one year after surgery in the two groups;the knee joint function of patients were evaluated by using the Lysholm score and the International Knee Joint Literature Committee Knee Joint Evaluation Form(IKDC)before and one year after surgery in the two groups;the incidence of postoperative complications of patients was compared between the two groups.Results The length of the femoral canal of patients in the trans-tibial tunnel group was significantly longer than that in the trans-anterior internal approach group(P<0.001),and the angle between the coronal centerline of the femoral canal and the joint line and the angle between the longitudinal axis of the femur and the femoral canal of patients were significantly greater than those in the trans-anterior internal approach group(P<0.001).One year after surgery,the negative rates of Lachman test and the negative rates of axial shift test of patients in the trans-tibial tunnel group were significantly lower than those in the trans-anterior internal approach group(P<0.05).There was no statistically significant difference in Lyshol
作者
王森
何芒
夏俊峰
张印
WANG Sen;HE Mang;XIA Junfeng;ZHANG Yin(No.1 Department of Bone,Nanyang First People′s Hospital,Nanyang 473000,Henan Province,China)
出处
《新乡医学院学报》
CAS
2023年第10期945-949,共5页
Journal of Xinxiang Medical University
关键词
前交叉韧带重建
经胫骨隧道
经前内入路
膝关节稳定性
anterior cruciate ligament reconstruction
trans-tibial tunnel
trans-anterior approach
knee joint stability
