前交叉韧带重建术后骨道增宽的临床研究

目的分析前交叉韧带（ACL）重建术后骨道增宽的发生率、增宽程度、骨道形状、相关因素及其与临床效果的关系。方法回顾性研究应用胭绳肌腱重建ACL手术后骨道的变化,通过X线片测量ACL重建术后的骨道直径。对51例患者行ACL重建手术,其中男性30例,女性21例。所有患者均获随访,平均随访时间16个月。主要研究及观察指标：患者性别、年龄、身高等因素,移植物的固定方式,随访时的关节活动度、膝关节稳定性检查（KT2000）及肌力恢复情况,以及股骨和胫骨的骨道直径、骨道位置和角度等。数据分析采用统计学卡方检验及相关性分析。结果前交叉韧带重建术后的骨道增宽率股骨85％-94％,胫骨65％;增宽程度股骨51％-53％,胫骨40％～44％。胫骨骨道增宽的形态以O型（冠位片）及V型（矢位片）最常见。骨道增宽与年龄、身高及体重指数相关。股骨骨道位置偏前会引起股骨骨道的增宽,股骨骨道角或胫骨骨道角越小,则股骨骨道越容易增宽。结论以腘绳肌腱为移植物重建前交叉韧带手术,术后骨道增宽的发生率与程度,股骨骨道较胫骨骨道明显。骨道增宽与患者年龄、身高以及骨道定位相关,其中股骨和胫骨骨道的位置及角度是引起术后骨道增宽的主要因素之一。骨道增宽与KT2000结果和术后肌力恢复情况相关。

Clinical study of bone tunnel expansion in anterior cruciate ligament reconstruction

OBJECTIVES: To mesasure the size and change of bone tunnel in arthroscopic assisted anterior cruciate ligament (ACL) reconstruction with hamstring tendon autograft by X-ray, and evaluate the incidence, extent, shape and reasons of the bone tunnel expansion and analyze the relationship between bone tunnel expansion and clinical results. METHODS: Fifty-one cases of arthroscopic ACL reconstruction with hamstring tendon autograft were performed, and they were followed up at average of 16 months postoperatively. The diameter, shape, position and angle of femoral and tibial bone tunnel were measured using X-ray, and other clinical information had been collected including gender, age, method of tibial fixation, range of motion, KT 2000 and evaluation of muscle strength and so on. All data were entered into the computerized relational database to analyze and compare using the chisquare test and correlation analysis. RESULTS: The incidence of tunnel expasion after ACL reconstruction was 85%-94% in femoral tunnel and 65% in tibial tunnel. The extent of tunnel expansion was 51%-53% in femoral tunnel and 40%-44% in tibial tunnel. The most common shape of tibial tunnel was type O in the A-P X-ray view and type V in the lateral X-ray view. Femoral tunnels anterior to the expected ones were more likely to enlarge. Tibial tunnels anterior to the expected ones were easier to expand. An acute tibial or femoral tunnel angle could result in the femoral tunnel expansion. CONCLUSIONS: The incidence and extent of bone tunnel expansion in arthroscopic ACL reconstruction with hamstring tendon autograft are more significant in femoral tunnel than in tibial tunnel. Bone tunnel expansion is correlated to patients' age, height, BMI and location of the tunnel. The main factors related to bone tunnel expansion are the location and angle of the tunnel.