胫骨骨道定位对前交叉韧带单束重建的影响

[目的]探讨胫骨骨隧道定位对前交叉韧带单束重建术后临床疗效的影响.[方法]将60例前交叉韧带断裂患者随机分为对照组和观察组.对照组胫骨骨隧道内口采用外侧半月板游离缘的切线与前后髁间突连线的交点定位；观察组选择原前内侧束和后外侧束中间位置定位.术后矢状位MRI测量胫骨骨道位置、胫骨纵向位移、后交叉韧带指数、膝关节功能评分进行分析评价.[结果]对照组和观察组胫骨骨道分别位于胫骨平台全长的前(38.67±4.23)％和(34.21±2.46)％.胫骨纵向位移为(11.14±2.64)mm和(14.34±2.23)mm,上倾角为(56.2±4.3)°和(44.6±5.2)°,后交叉韧带指数为(3.97±0.45)和(4.78±0.78)；两组比较差异均有统计学意义(t检验,P＜0.05).术后1年,对照组与观察组IKDC膝关节主观评分分别为(79.63±4.67)分和(89.76±5.21)分；Lysholm评分分别为(85.61±4.92)分和(92.54±3.22)分,两组比较差异有统计学意义(t检验,P＜0.05).[结论]前交叉韧带单束重建能使患者的关节稳定性与功能均得到显著改善.膝关节MRI测量可较客观、准确地反映胫骨的骨道定位情况.理想的胫骨骨道在矢状位MRI上位于胫骨平台的前(34.21±2.46)％.

Effect of tibia tunnel position after single-bundle anterior cruciate ligament reconstruction

[Objective]To observe the clinical effect of tibia tunnel position after single-bundle anterior cruciate ligament(ACL) reconstruction.[Method]Sixty cases of anterior cruciate ligament rupture patients were randomized into control group and observation group.The tibial bone tunnel of control group was made using lateral meniscus free edge tangent before and after the intercondylar eminence connection point positioning,observation group using the intermediate position of anteromedial and posterolateral bundle.Sagittal MRI measurements of tibial tunnel position were done after operation,the tibial longitudinal displacement,posterior cruciate ligament index and knee function score were analyzed and evaluated.[Result]The tibial tunnel position of observation group and control group located in tibial plateau full-length front were(38.67±4.23) % and(34.21±2.46) %.Tibial longitudinal displacement were(11.14±2.64)mm and(14.34±2.23)mm,dip angle were(56.2±4.3)°and(44.6±5.2)°,posterior cruciate ligament index were(3.97±0.45) and(4.78±0.78),the difference between two groups as significant(P<0.05).One years after operation,the control group and observation group IKDC knee scores were(79.63±4.67) and(89.76±5.21).Lysholm score were(85.61±4.92) and(92.54±3.22),there was significant difference between two groups(t test,P<0.05).[Conclusion]Single-bundle anterior cruciate ligament reconstruction can make the joint stability and function improved significantly.Knee joint MRI measurements can be more objective,accurate reflection of tibial bone tunnel position.The optimal tibia tunnel position might be(34.21±2.46)% of the sagittal tibial diameter.