前交叉韧带单束重建中股骨椭圆隧道技术与圆隧道技术的比较研究

目的通过与传统圆隧道技术相比,探讨前交叉韧带(anterior cruciate ligament,ACL)单束重建中采用椭圆隧道技术制备股骨隧道的疗效及优势。方法回顾分析2016年3月-2018年2月125例采用自体肌腱单束解剖重建ACL且符合选择标准的患者临床资料,其中43例术中采用椭圆隧道技术制备股骨隧道(A组),82例采用圆隧道技术(B组)。两组患者年龄、性别、体质量指数、病程、损伤侧别、损伤原因以及术前Lysholm评分、国际膝关节文献委员会(IKDC)评分、Tegner评分、KT-1000测量值等一般资料比较,差异均无统计学意义(P>0.05)。记录两组患者术后3、6、12、24个月Lysholm评分、IKDC评分和Tegner评分,采用KT-1000评价关节稳定性。术后1d三维CT评估股骨和胫骨隧道位置。术后6、12、24个月MRI检查,测量ACL移植物近、中、远端信号/噪声比(signal/noise quotient,SNQ)。对行二次关节镜检查患者评价移植物完整性、滑膜覆盖以及张力情况。结果两组患者均获随访,随访时间12~26个月,平均23个月。A组2例、B组5例发生切口红肿,B组1例发生胫骨隧道裂纹骨折,A组1例发生膝关节屈曲活动度受限。除术后3个月Tegner评分外,其余各时间点A组Lysholm、IKDC、Tegner评分均明显高于B组(P<0.05)。术后各时间点A组KT-1000测量值亦明显小于B组(P<0.05)。术后1 d三维CT检查示两组股骨及胫骨隧道均位于ACL止点印迹内。MRI复查两组均无移植物断裂及明显松弛发生。术后6个月两组移植物中、远端SNQ差异无统计学意义(P>0.05),近端A组明显低于B组(P<0.05);术后12、24个月A组移植物近、中、远端SNQ均低于B组(P<0.05)。A组21例及B组38例患者进行二次关节镜检查,两组移植物完整性、滑膜覆盖及张力比较,差异均无统计学意义(P>0.05)。结论与传统圆隧道技术相比,ACL单束重建术中采用椭圆隧道技术制备股骨隧道,术后移植物成熟度更好,患者能获得更好膝关节功能。

Comparison of femoral oval tunnel technique and round tunnel technique in singlebundle anterior cruciate ligament reconstruction

Objective To evaluate the effectiveness of femoral oval tunnel technique versus round tunnel technique in single-bundle anterior cruciate ligament(ACL)reconstruction.Methods Between March 2016 and February 2018,125 patients who underwent anatomical single-bundle ACL reconstruction with hamstring tendon and met the inclusive criteria were included in the retrospective study.Of the included patients,43 patients underwent ACL reconstruction using oval tunnel technique(group A)and 82 patients with round tunnel technique(group B).There was no significant difference between the two groups in terms of age,gender,body mass index,the interval between injury and operation,the injured side,the cause of injury,and preoperative Lysholm score,International Knee Documentation Committee(IKDC)score,Tegner score,and the outcome of KT-1000 measurement(P>0.05).At 3,6,12,and 24 months after operation,the knee function scores(Lysholm score,IKDC score,Tegner score)were recorded;and KT-1000 was used to evaluate the knee stability.The position and shape of the tunnels were evaluated by the three-dimensional CT(3 DCT)at 1 day after operation;and MRI was performed at 6,12,and 24 months to calculate the signal/noise quotient(SNQ)of ACL grafts.Secondary arthroscopy was conducted to estimate the graft status,synovial coverage,and tension.Results All patients were followed up 12-26 months(mean,23 months).Two patients in group A and 5 patients in group B presented with redness and swelling of the surgical site,1 patient in group B sustained a tibial tunnel fracture,and1 patient in group A had postoperative stiffness.The Lysholm score,IKDC score,and Tegner score were significantly higher in group A than in group B at the different time points(P<0.05)except for the Tegner score at 3 months.The outcomes of KT-1000 measurement were significantly lower in group A than in group B(P<0.05).The entrances of the femoral tunnel and tibial tunnel in both groups were within the ACL anatomical footprint confirmed by 3 D-CT.No rerupture of ACL occurred confirmed by the MRI.There was no significant difference in SNQs of the middle and distal grafts between the two groups at 6 months(P>0.05),whereas the SNQ of the proximal grafts in group A was significantly lower than that in group B(P<0.05).The SNQs of the proximal,middle,and distal grafts in group A were significantly lower than those in group B at 12 and 24 months after operation(P<0.05).Twenty-one patients in group A and 38 patients in group B underwent secondary arthroscopy and the results showed no significant difference in graft status,synovial coverage,and tension between the two groups(P>0.05).Conclusion The effectiveness and graft maturity of the femoral oval tunnel technique were superior to the round tunnel technique.The single-bundle ACL reconstruction with femoral oval tunnel technique can obtain a better knee function.