ACL断裂单束解剖重建及胫骨隧道扩大的临床研究

目的　探讨前交叉韧带单束解剖重建术后胫骨隧道扩大对临床效果的影响。 方法　回顾性分析我科在2011年5月至2012年12月行关节镜下前交叉韧带单束解剖重建术的40例（40膝）患者资料，通过膝关节X线片、CT及三维重建测量胫骨隧道宽度后，对骨隧道扩大进行分级及定义。采用膝关节活动度（range of motion, ROM）、前抽屉试验（anterior drawer test ADT）、Lachman试验、轴移试验（pivot shift test, PST）、Lysholm评分表、IKDC2000评分表评定临床疗效。 结果　术后随访未发现关节屈伸活动障碍者。术后患侧活动度与健侧活动度，两者间差异无统计学意义（t =-1.844，P =0.069）。骨隧道扩大组与非扩大组间ADT、Lachman和PST差异无统计学意义（χ2 =1.314、0.011、0.005，P =0.33、1.0、1.0）。40例患者术前Lysholm评分与术后Lysholm评分、两者差异有统计学意义（t =-45.50，P <0.001）；术前IKDC2000评分与术后IKDC2000评分两者差异有统计学意义（t =-25.18，P <0.001）。骨隧道扩大各级别间Lysholm评分差异无统计学意义（F =1.274，P =0.292），各级别两两间差异无统计学意义。 结论　膝关节镜下单束解剖前交叉韧带重建术后胫骨隧道扩大对患者中期临床疗效没有明显影响。

The study of the tibial tunnel enlargement andmedium-term clinical effects after anatomical single bundle anterior cruciate ligament reconstruction

Objective　To explore the effect of tibial tunnel enlargement on the clinical outcome after anatomical single bundle anterior cruciate ligament (ACL) reconstruction.　Method　The clinical data of 40 patients who had received anatomical single-bundle ACL reconstruction from May 2011 to December 2012 in affiliated hospital of Cheng De medical college were reviewed. After measuring the tibial bone tunnel width through X-ray films, CT scanning and three-dimensional reconstruction, The bone tunnel enlargement is classified and defined. To evaluate the clinical outcome, range of motion (ROM), anterior drawer test (ADT), Lachman Test, pivot shift test (PST)，the Lysholm Knee Scoring Scale and IKD C2000 Scoring Scale were adopted.　Results　During postoperative follow-up,there was no activity disabilities of joint flexion and extension. Between affected limb and the contralateral limb flexion angle there was no statistically significant difference (t=-1.844, P=0.069).There was no statistically significant difference between the two groups in ADT、Lachman test and PST (χ2=1.314,0.011,0.005, P=0.33、1.0、1.0). Comparing the preoperative Lysholm score with postoperative score in the 40 patients, There was statistically significant difference(t=-45.50, P<0.001). Comparing the preoperative IKDC score with postoperative score in the 40 patients, there was statistically significant difference (t=-25.18, P＜0.001). According to tibial tunnel diameter of 3D-CT, there was no statistically significant difference among all Lysholm score in different levels (F=1.274, P=0.292), and there was no statistically significant difference between any two levels.　Conclusion　The tibial tunnel enlargement after anatomical single bundle ACL reconstruction has no significant effect on medium-term clinical outcomes.