单束重建前交叉韧带骨道位置对临床效果影响的研究

目的:探讨前交叉韧带重建术骨道位置对临床效果的影响。方法:2005年5月至12月于我所行自体腘绳肌腱单束重建前交叉韧带手术患者72例,采用其侧位X线平片测量骨道位置,结合膝关节功能评分、KT-2000测试结果进行分析。结果:患者的IKDC、Lysholm和Tegner评分以及KT-2000在134N下屈膝30度和90度位膝关节前后位移情况均较术前显著改善(P<0.01)。股骨骨道位于Blumensaat’s线的后23.87%,胫骨骨道位于胫骨平台全长的前38.25%。膝关节伸直受限患者胫骨骨道位于胫骨平台前34.19%,伸直正常患者胫骨骨道位于胫骨平台的前38.91%,二者相比具有显著性差异(P<0.05〉。KT-2000屈膝30度位膝关节前后位移值大于等于3mm患者的胫骨骨道位于胫骨平台的前44.78%,位移小于3mm患者胫骨骨道位于胫骨平台的37.39%,二者相比具有显著性差异(P<0.01)。结论:单束重建前交叉韧带手术使患者关节稳定性与功能均得到显著改善。X线测量可较客观、准确地反映骨道定位情况,骨道位置与临床效果相关;本次研究显示比较理想的骨道位置在X线侧位片上位于胫骨平台的前34~37%。

Postoperative Evaluation of Tunnel Position by Radiography after Single-Bundle Anterior Cruciate Ligament Reconstruction

Objective To find out the optimal position of the tunnel on the lateral plain radiography after single-bundle anterior cruciate ligament(ACL) reconstruction.Methods From May to December 2005,72 patients undertook single-bundle ACL reconstruction with auto hamstring tendons were investigated retrospectively.The femoral and tibia tunnel's positions were measured by lateral plain radiography and knee function were evaluated by KT-2000 as well as IKDC,Lycholm and Tegner scores.Results The IKDC,Lysholm and Tegner scores were increased significantly from 51.08±23.94,55.95±28.46,and 3.13±2.25 pre-operation to 87.99±9.81,91.72±9.61,and 6.46±1.43 postoperation respectively.The KT2000 results showed that the anterior-posterior displacement at 30 and 90 degree flexion under 134N were significantly decreased from 5.66±1.71 and 2.41±0.91 to 1.64±1.48 and 1.08±1.18 respectively(P<0.01).The femoral tunnel center was located at the posterior 23.87% of the length of the Blumensaat's line.The tibia tunnel center was located at the 38.25% of the sagittal tibial diameter.The tibia tunnel's positions of those patients with knee extension restrict were significant anterior than those patients without restriction(34.19% vs 38.91%,P<0.05).The tibia tunnel's positions of those patients with anterior-posterior displacement lower than 3 mm showed a significant anterior tunnel than those paitents whose displacement equal or higher than 3 mm(37% vs 45%,P<0.01).Conclusion Single-bundle ACL reconstruction could improve knee's stability and it's function.Radiography could reflect the tunnel positions objectively,which were related to the clinical outcomes.The optimal femoral tunnel might be the last quarter of the length of the Blumensaat's line.The optimal tibia tunnel position might be 34%～37% of the sagittal tibial diameter.